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intravena  vs oral antibiotic untuk infeksi tulang yang serius pada anak-anak

Anak-anak dengan osteomielitis - infeksi tulang bakteri yang serius - yang keluar dari rumah sakit untuk menyelesaikan beberapa minggu terapi antibiotik secara rawat jalan dengan obat oral tidak memiliki tingkat yang lebih tinggi dari kegagalan pengobatan daripada anak-anak yang menerima terapi antibiotik intravena , menurut sebuah studi ....read more

Intravenous vs.
oral antibiotics for serious bone infections in children

Date:

December 15, 2014

Source:

The JAMA Network
Journals

Summary:

Children with
osteomyelitis -- a serious bacterial bone infection -- who were discharged from
the hospital to complete several weeks of outpatient antibiotic therapy with an
oral medication did not have a higher rate of treatment failure than children
who received their antibiotic therapy intravenously, according to a study.

........................

children with
osteomyelitis (a serious bacterial bone infection) who were discharged from the
hospital to complete several weeks of outpatient antibiotic therapy with an
oral medication did not have a higher rate of treatment failure than children
who received their antibiotic therapy intravenously, according to a study
published online by JAMA Pediatrics.
........................................

How children receive their outpatient antibiotic therapy impacts both them
and their caregivers. While a peripherally inserted central catheter (PICC) is
effective at delivering high concentrations of antibiotic it can result in
serious complications such as infections and blood clots. Oral medication is an
appealing alternative but clinical trials have not documented its effectiveness
for osteomyelitis, according to the study background.



Bagaimana anak-anak menerima dampak terapi antibiotic rawat jalan mereka baik mereka
dan caregivers mereka . Sementara peripherally inserted central catheter ( PICC ) adalah
efektif memberikan konsentrasi tinggi antibiotik dapat mengakibatkan
komplikasi serius seperti infeksi dan pembekuan darah . Obat oral adalah
uji alternatif tetapi klinis belum didokumentasikan efektivitasnya
untuk osteomyelitis , menurut latar belakang studi .


..........................

Ron Keren, M.D., M.P.H., of the Children's Hospital of Philadelphia, and
co-authors compared the effectiveness and adverse outcomes of post-discharge
antibiotic therapy delivered by pills or intravenously. Authors analyzed
medical record data comparing the two antibiotic methods in children discharged
from 36 hospitals from 2009 through 2012. The analysis included 2,060 children
and adolescents with osteomyelitis (1,005 who received oral antibiotics at
discharge and 1,055 given antibiotics delivered through a PICC). Most of the
children were male, who ranged in age from 5 to 13 years old, and the most
common site of infection was the lower extremity (lower leg, ankle, foot; the
pelvis and thigh).

Study results indicate that children treated with oral antibiotics did not
experience more treatment failures than those treated with PICC-delivered
antibiotics (5 percent vs. 6 percent, respectively). Rates of adverse drug
reaction also were low (less than 4 percent in both groups). Among children in
the PICC group, 158 of them (15 percent) had a PICC complication that sent them
back to the hospital for an emergency department visit, rehospitalization or
both.

"Given the magnitude (15 percent of all children in the PICC group)
and gravity (i.e., bloodstream infection, thromboembolism and line breakage) of
the PICC-related complications, clinicians should reconsider the practice of
treating otherwise healthy children with osteomyelitis with prolonged IV
therapy when an effective oral alternative exists," the study concludes.

Editorial: Outpatient Antibiotic Therapy for Acute Osteomyelitis in
Children

In a related editorial, Pranita D. Tamma, M.D., M.H.S., and Aaron M.
Milstone, M.D., M.H.S., of the Johns Hopkins University School of Medicine, write:
"In summary, this study addresses an important question with obvious
implications for children and their caregivers hoping to avoid PICC-associated
complications. In the absence of data demonstrating that long-term IV
antibiotics enhance clinical outcomes compared with oral therapy, clinicians
should strongly consider transition to oral antibiotic therapy at the time of
discharge for the treatment of acute osteomyelitis in otherwise healthy
children," the authors conclude.







Story Source:

The above story is based on materials provided by The
JAMA Network Journals.Note: Materials may be edited for content and length.







Journal References:

1.    Ron Keren, Samir S. Shah, Rajendu
Srivastava, Shawn Rangel, Michael Bendel-Stenzel, Nada Harik, John Hartley,
Michelle Lopez, Luis Seguias, Joel Tieder, Matthew Bryan, Wu Gong, Matt Hall,
Russell Localio, Xianqun Luan, Rachel deBerardinis, Allison Parker. Comparative
Effectiveness of Intravenous vs Oral Antibiotics for Postdischarge Treatment of
Acute Osteomyelitis in Children.JAMA Pediatrics, 2014; DOI: 10.1001/jamapediatrics.2014.2822

2.    Pranita D. Tamma, Aaron M.
Milstone. Outpatient Antibiotic Therapy for Acute Osteomyelitis in
Children. JAMA Pediatrics, 2014; DOI:10.1001/jamapediatrics.2014.2850

http://www.sciencedaily.com/releases/2014/12/141215185310.htm

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