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Ambulatory intravenous antibiotic therapy for children with preseptal cellulitis
Rossa E Brugha1, Ed Abrahamson
1Paediatric Emergency Department, Chelsea and Westminster NHS Trust, London, United Kingdom.
Insights
Outpatient ambulatory care with intravenous antibiotics is a safe and cost-effective alternative to hospital admission for children with preseptal cellulitis. This approach reduces costs without compromising treatment duration or complication rates.
Area of Science:
- Pediatric Emergency Medicine
- Infectious Diseases
- Health Economics
Background:
- Preseptal cellulitis is a common pediatric condition requiring antibiotic treatment.
- Current management often involves inpatient admission for intravenous antibiotics.
- Alternative management strategies are needed to optimize resource utilization.
Purpose of the Study:
- To compare the efficacy and cost-effectiveness of outpatient ambulatory care versus inpatient admission for intravenous antibiotic management of preseptal cellulitis in children.
- To evaluate treatment duration and complication rates between the two management approaches.
Main Methods:
- Retrospective consecutive cohort study.
- Inclusion of children under 16 years presenting with preseptal cellulitis to a pediatric emergency department.
- Analysis of treatment outcomes, duration, and complications for ambulatory versus admitted patients.
Main Results:
- No significant difference in treatment duration (2.79 ± 0.8 vs 2.76 ± 1.9 days) or complication rates between ambulatory and admitted groups.
- Significant cost savings of $4900 per patient with ambulatory management.
- Out of 94 cases, 42 were managed ambulatory and 21 admitted for intravenous antibiotics.
Conclusions:
- Ambulatory intravenous antibiotic management with daily review is a safe and effective alternative for children with preseptal cellulitis requiring parenteral antibiotics.
- This approach offers substantial cost savings compared to inpatient admission.
- Supports a shift towards outpatient management for selected pediatric cases.
Objective:
This study aimed to compare the use of outpatient ambulatory care versus admission for intravenous antibiotics in the management of preseptal cellulitis.
Methods:
This is a retrospective consecutive cohort study of children younger than 16 years presenting to an Inner London Paediatric Emergency Department with signs and symptoms of preseptal cellulitis.
Results:
A total of 94 cases were identified during a 17-month period. Of them, 30 children were prescribed oral antibiotics. One child did not receive treatment. Of the 63 children prescribed with intravenous antibiotics, 42 were managed on an ambulatory basis and 21 were admitted. There was no significant difference in duration of treatment in days between those on ambulatory management and those admitted (2.79 ± 0.8 vs 2.76 ± 1.9, P = 0.94) or in the rate of complications. The net cost saving was $205,924 (£131,065; &OV0556;147,578) overall, equal to $4900 (£3120; &OV0556;3513) per patient.
Conclusions:
Ambulatory intravenous antibiotics with daily review are a safe and cost-effective alternative to inpatient admission in simple preseptal cellulitis for children in our population who require parenteral antibiotics.
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