| Prolonged intravenous therapy versus early transition to oral antimicrobial therapy for acute osteomyelitis in children. | |
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MedLine Citation:
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PMID: 19171632 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: Early transition from intravenous to oral antimicrobial therapy for acute osteomyelitis in children has been suggested as a safe and effective alternative to traditional prolonged intravenous therapy via central venous catheter, but no studies have directly compared these 2 treatment modalities. We sought to compare the effectiveness of early transition from intravenous to oral antimicrobial therapy versus prolonged intravenous antimicrobial therapy for the treatment of children with acute osteomyelitis. METHODS: We conducted a retrospective cohort study of children aged 2 months to 17 years diagnosed with acute osteomyelitis between 2000 and 2005 at 29 freestanding children's hospitals in the United States to confirm the extent of variation in the use of early transition to oral therapy. We used propensity scores to adjust for potential differences between children treated with prolonged intravenous therapy and logistic regression to model the association of outcome (treatment failure rates within 6 months of diagnosis) and difference in the mode of therapy within hospitals and across hospitals. RESULTS: Of the 1969 children who met inclusion criteria, 1021 received prolonged intravenous therapy and 948 received oral therapy. The use of prolonged intravenous therapy varied significantly across hospitals (10%-95%). The treatment failure rate was 5% (54 of 1021) in the prolonged intravenous therapy group and 4% (38 of 948) in the oral therapy group. There was no significant association between treatment failure and the mode of antimicrobial therapy. Thirty-five (3.4%) children in the prolonged intravenous therapy group were readmitted for a catheter-associated complication. CONCLUSIONS: Treatment of acute osteomyelitis with early transition to oral therapy is not associated with a higher risk of treatment failures and avoids the risks of prolonged intravenous therapy through central venous catheters. |
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Authors:
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Theoklis Zaoutis; A Russell Localio; Kateri Leckerman; Stephanie Saddlemire; David Bertoch; Ron Keren |
Publication Detail:
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Type: Journal Article; Research Support, N.I.H., Extramural |
Journal Detail:
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Title: Pediatrics Volume: 123 ISSN: 1098-4275 ISO Abbreviation: Pediatrics Publication Date: 2009 Feb |
Date Detail:
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Created Date: 2009-01-27 Completed Date: 2009-03-05 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0376422 Medline TA: Pediatrics Country: United States |
Other Details:
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Languages: eng Pagination: 636-42 Citation Subset: AIM; IM |
Affiliation:
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Division of Infectious Diseases, Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, CHOP North, Suite 1527, Philadelphia, PA 19104, USA. zaoutis@email.chop.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Acute Disease Administration, Oral Adolescent Anti-Bacterial Agents / administration & dosage* Catheterization, Central Venous Child Child, Preschool Cohort Studies Female Humans Infant Male Osteomyelitis / drug therapy* Retrospective Studies Time Factors Treatment Failure |
| Grant Support | |
ID/Acronym/Agency:
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HS10399/HS/AHRQ HHS; K23 AI0629753-01/AI/NIAID NIH HHS; K23 HD043179/HD/NICHD NIH HHS |
| Chemical | |
Reg. No./Substance:
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0/Anti-Bacterial Agents |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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