Choosing Wisely:

Don’t prescribe IV antibiotics for predetermined durations for patients hospitalized with infections such as pyelonephritis, osteomyelitis and complicated pneumonia. Consider early transition to oral antibiotics.

Rationale and Comments: Recent publications have demonstrated that strategies for early transition to oral antibiotics achieve equal or better outcomes for common inpatient infections and are safer than prolonged intravenous antibiotics in children. The use of intravenous lines such as peripherally inserted central catheters, which are often necessary for prolonged intravenous antibiotics, can lead to complications such as thrombosis or line infections. Antibiotic courses with predetermined durations are often not based on high-quality evidence and ignore individual response to treatments, which can vary significantly from patient to patient. Once a patient is able to tolerate them, early transition to oral antibiotics, based on individual patient clinical responses such as defervescence and other symptoms and signs of improvement, are patient and family centered and can improve the value of care for hospitalized children.
Sponsoring Organizations:
  • Pediatric Hospital Medicine – SHM, AAP, APA
  • Sources:
  • Retrospective cohort study
  • Disciplines:
  • Pediatric
  • Infectious disease
  • References: • Keren R, et al.; Pediatric Research in Inpatient Settings Network. Comparative effectiveness of intravenous vs oral antibiotics for post-discharge treatment of acute osteomyelitis in children. JAMA Pediatr. 2015;169(2):120-8.
    • Subcommittee on Urinary Tract Infection, Steering Committee on Quality Improvement and Management, Roberts KB. Urinary tract infection: clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months. Pediatrics. 2011;128(3):595-610.
    • Shah SS, et al.; Pediatric Research in Inpatient Settings Network. Intravenous versus oral antibiotics for post-discharge treatment of complicated pneumonia. Pediatrics. 2016;138(6): e20161692.
    • Schroeder AR, et al. Intravenous antibiotic durations for common bacterial infections in children: when is enough enough? J Hosp Med. 2014;9(9):604-609.

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