Related Experiment Video
Updated: Mar 30, 2026
A Retrospective Study on Endoscopic Surgery for the Treatment of Paravertebral Abscess in Spinal Tuberculosis Patients
Published on: October 25, 2024
Comparative Effectiveness of Oral Versus Outpatient Parenteral Antibiotic Therapy for Empyema
Chris Stockmann1, Krow Ampofo1, Andrew T Pavia1
1Departments of Pediatrics and.
Insights
For pediatric parapneumonic empyema (PPE), oral antibiotic therapy and outpatient parenteral antibiotic therapy (OPAT) showed similar complication rates. Oral antibiotics are a safe and effective option for children completing PPE treatment at home.
Area of Science:
- Pediatric Infectious Diseases
- Pulmonary Medicine
- Clinical Outcomes Research
Background:
- Pediatric parapneumonic empyema (PPE) treatment necessitates prolonged antibiotic courses, often completed outpatiently via oral or intravenous (outpatient parenteral antibiotic therapy [OPAT]) routes.
- Existing literature lacks comparative outcome data between oral and OPAT for pediatric PPE management.
Purpose of the Study:
- To compare the incidence of all-cause complications in children with PPE treated with oral antibiotics versus OPAT after hospital discharge.
Main Methods:
- A retrospective cohort study identified children under 18 with PPE from 2005-2014.
- All-cause complications (pneumonia-related or antibiotic-related) leading to readmission or urgent care visits were assessed.
- Propensity score-weighted logistic regression analyzed complication rates between oral therapy and OPAT groups.
Main Results:
- Of 391 children with PPE, 337 received OPAT. Overall complication rates were similar: 9.3% for oral therapy and 8.9% for OPAT.
- Pneumonia-related and treatment-related complications did not differ significantly between groups.
- Adjusted analysis confirmed comparable complication frequencies (aOR 0.97; 95% CI 0.23-4.65).
Conclusions:
- Oral antibiotic therapy and OPAT demonstrate similar complication frequencies in pediatric PPE patients.
- Oral antibiotics represent a safe and effective outpatient treatment option for children with PPE.
Background:
Treatment of pediatric parapneumonic empyema (PPE) requires several weeks of antibiotic therapy that is typically completed in the outpatient setting. The route of outpatient therapy can be oral or intravenous (outpatient parenteral antibiotic therapy [OPAT]). No studies have compared outcomes between oral therapy and OPAT for PPE.
Methods:
We identified children <18 years hospitalized from 2005 to 2014 at Primary Children's Hospital with PPE and discharged with oral therapy or OPAT. The primary outcome was the percentage of children who experienced all-cause complications after discharge. Complications included those that were related to pneumonia (including treatment failure, defined as readmission with reaccumulation of pleural fluid or abscess requiring drainage) or antibiotic therapy (eg, allergy, line clot) resulting in either a hospital readmission or emergency department/urgent care visit. All-cause complications were compared between oral therapy and OPAT by using propensity score-weighted logistic regression.
Results:
A total of 391 children were hospitalized with PPE; 337 (86%) were discharged with OPAT; 35 (9%) children experienced an all-cause complication, including 5 with oral (9.3%) and 30 (8.9%) with OPAT. Pneumonia and treatment-related complications were comparable (P = .25 and .78, respectively). Two patients treated with OPAT (1%) experienced treatment failure. After adjustment using propensity score weighting, the frequency of complications was similar between groups (adjusted odds ratio 0.97, 95% confidence interval 0.23-4.65).
Conclusions:
The frequency of complications was similar with oral therapy and OPAT for children with PPE. Oral antibiotics may be considered safe and effective for children with PPE who will be discharged to complete therapy in the outpatient setting.
More Related Videos
09:17A Robust Pneumonia Model in Immunocompetent Rodents to Evaluate Antibacterial Efficacy against S. pneumoniae, H. influenzae, K. pneumoniae, P. aeruginosa or A. baumannii
Published on: January 2, 2017
09:26Antibiotic Efficacy Testing in an Ex vivo Model of Pseudomonas aeruginosa and Staphylococcus aureus Biofilms in the Cystic Fibrosis Lung
Published on: January 22, 2021
Related Concept Videos
01:28Acute Pyelonephritis II: Diagnostic Studies and Management
01:22Pharmaceutical Alternatives: Stability-Related Therapeutic Nonequivalence
01:26Tonsillitis II: Management
01:28Pneumonia IV: Management
Bacterial Pneumonia Treatment
For bacterial pneumonia, antibiotics serve as the cornerstone of therapy. Initial treatment often begins with empirical antibiotics, tailored to the anticipated causative organism and adjusted based on culture results. Key antibiotic choices include:
01:20Sputum Studies II: Culture and Sensitivity
Sputum culture and sensitivity is a medical procedure used to diagnose bacterial infections in the respiratory tract and select the most appropriate antibiotics for treatment. This process involves analyzing sputum samples of thick and opaque secretions produced in the lungs and airways. These samples are collected from patients and then sent to the laboratory for analysis.
The test can identify various pathogens responsible for respiratory infections, including Streptococcus,...
01:28Pulmonary Tuberculosis V
Latent tuberculosis infection occurs when TB bacteria are present in a person's body, but are not causing illness or symptoms. It is not contagious, and preventive treatment is crucial to avoid the...