Choosing Wisely:

Don’t place peripherally inserted central catheters and/or use prolonged intravenous antibiotics in otherwise healthy children with infections that can be transitioned to an appropriate oral agent.

Rationale and Comments: Peripherally inserted central catheters (PICCs) are often used for children requiring long-term intravenous antibiotics. The most common infections for which PICCs are placed in children, however, respond well to orally administered antibiotics after a brief course of intravenous therapy. Following hospital discharge, up to 40% of children with PICCs will return to the emergency department with a PICC complication. Studies of children with complicated pneumonia, ruptured appendicitis, and osteomyelitis have demonstrated that, compared with oral conversion prior to hospital discharge, extended intravenous therapy with a PICC does not improve clinical cure rates but is often associated with PICC line complications.
Sponsoring Organizations:
  • American Academy of Pediatrics – Committee on Infectious Diseases and the Pediatric Infectious Diseases Society
  • Sources:
  • Expert consensus
  • Disciplines:
  • Infectious disease
  • Pediatric
  • References: • Ruebner R, Keren R, Coffin S, et al. Complications of central venous catheters used for the treatment of acute hematogenous osteomyelitis. Pediatrics. 2006 Apr;117(4):1210-5.
    • Kovacich A, Tamma PD, Advani S, et al. Peripherally Inserted Central Venous Catheter Complications in Children Receiving Outpatient Parenteral Antibiotic Therapy (OPAT). Infect Control Hosp Epidemiol. 2016 Apr;37(4):420-4. doi: 10.1017/ice.2015.317. Epub 2016 Jan 12.
    • Keren R, Shah SS, Srivastava R et al. Comparative effectiveness of intravenous vs oral antibiotics for postdischarge treatment of acute osteomyelitis in children. JAMA Pediatr. 2015 Feb;169(2):120-8. doi: 10.1001/jamapediatrics.2014.2822.
    • Rangel SJ, Anderson BR, Srivastava R, et al. Intravenous Versus Oral Antibiotics for the Prevention of Treatment Failure in Children With Complicated Appendicitis: Has the Abandonment of Peripherally Inserted Catheters Been Justified? Ann Surg. 2016 Jul 15. [Epub ahead of print]
    • Shah SS, Srivastava R, Wu S, et al. Intravenous Versus Oral Antibiotics for Postdischarge Treatment of Complicated Pneumonia. Pediatrics. 2016 Dec;138(6). pii: e20161692. Epub 2016 Nov 17.

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