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Parenteral antibiotics for UTIs do not decrease readmission rates
Over one-third of young children presenting to EDs for the treatment of urinary tract infections receive both parenteral and oral antibiotics before discharge. This practice, according to study findings published in Pediatrics, does not decrease the risk for readmission and is noninferior to administering oral antibiotics alone.
“Oral antibiotics are as effective as parenteral antibiotics in the treatment of UTIs in young children, and outpatient management with oral antibiotics alone is recommended for most young children with UTIs who are able to tolerate oral intake and are not ill appearing,” Pradip P. Chaudhari, MD, associate research director and attending physician in the Children’s Hospital of Los Angeles’ department of emergency and transport medicine, and assistant professor of clinical pediatrics at the Keck School of Medicine at the University of Southern California, and colleagues wrote.
The results of a previously published small study demonstrated that when one dose of ceftriaxone was used in conjunction with oral antibiotics, patient outcomes were noninferior to oral antibiotics alone. Despite these findings, parenteral antibiotics are commonly administered to children with UTIs before discharge from the ED.
Chaudhari and colleagues examined the association between parenteral antibiotic use before discharge from the ED and readmission among children who received this medication for UTI treatment by conducting a retrospective analysis. The analysis included data on patients aged between 29 days and 2 years who presented with a UTI to the EDs of 36 pediatric hospitals in the United States.
Between 2010 and 2016, 29,919 children (median age, 8.6 months) presented to an ED with a UTI, Parenteral antibiotics were given to 36% of patients before discharge. These children had a comparable adjusted rate of readmission to those who received only oral antibiotics (1.3% vs. 1%; risk difference, 0.3%; 95% CI, –0.01 to 0.6%).
Although adjusted rates of readmission were similar between those who were administered parenteral antibiotics and those who did not, children who received parenteral antibiotics had higher overall rates of revisits compared with children who received only oral antibiotics (4.8% vs. 3.3%; risk difference = 1.5%; 95% CI, 0.9%-2.1%).
“Although a dose of parenteral antibiotics is generally safe, this practice requires additional resources, can be painful and exposes the patient to additional antibiotics,” Chaudhari and colleagues wrote. “Despite the evidence from aforementioned studies and the AAP’s recommendation, single-dose parenteral antibiotic therapy before ED discharge remains common practice for the management of UTIs… We can only speculate on the clinical reasoning for this practice, but it likely includes the clinician’s consideration of illness severity, concerns of tolerance of oral antibiotics and potential to reduce outpatient treatment failures.” – by Katherine Bortz
Disclosures: The authors report no relevant financial disclosures.
