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.

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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.