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Outpatient therapy of serious pediatric infections with ceftriaxone
J S Bradley1, D K Ching, S E Phillips
1Department of Pediatrics, Oregon Children's Medical Center, Emanuel Hospital, Portland.
Insights
Outpatient antibiotic therapy with ceftriaxone is a safe and effective option for children with serious bacterial infections. This approach, involving daily physician visits, can reduce hospital readmissions when patients are clinically stable.
Area of Science:
- Pediatric Infectious Diseases
- Antimicrobial Stewardship
- Clinical Pharmacology
Background:
- Serious bacterial infections in children often require prolonged hospitalization.
- Outpatient parenteral antibiotic therapy (OPAT) offers a potential alternative to inpatient care.
- Ceftriaxone is a broad-spectrum cephalosporin commonly used for bacterial infections.
Purpose of the Study:
- To evaluate the safety and efficacy of convalescent outpatient parenteral antibiotic therapy with ceftriaxone in children.
- To establish criteria for selecting pediatric patients suitable for OPAT.
- To assess the feasibility of once-daily dosing regimens.
Main Methods:
- An uncontrolled study involving 101 children with documented serious bacterial infections, including meningitis.
- Patients were discharged from the hospital when risks of complications were minimal.
- Daily physician visits and parental support were integral to outpatient management.
- Ceftriaxone was administered once daily for non-central nervous system infections and intravenously once or twice daily for meningitis.
Main Results:
- Mean therapy durations were 2.4 days for non-central nervous system infections and 4.6 days for meningitis.
- No patients required hospital readmission for medical or social reasons.
- Diarrhea occurred in 13% of meningitis patients and 6% of non-central nervous system infection patients.
- One case of pseudomembranous colitis was observed in a meningitis patient.
Conclusions:
- Single daily dose outpatient ceftriaxone therapy is a viable option for pediatric patients with susceptible bacterial infections.
- Successful OPAT requires demonstrated clinical response and minimal disease-related complication risks.
- Careful patient selection and close monitoring are crucial for safe and effective outpatient antibiotic management.
Abstract:
Convalescent outpatient parenteral antibiotic therapy with ceftriaxone was evaluated in an uncontrolled study of 101 children with documented serious bacterial infections, including meningitis. Criteria for outpatient therapy were established to assure that risks of complications from the illness were minimal at the time of discharge from the hospital. Daily physician visits and motivated, capable parents were considered essential in outpatient management. Ceftriaxone was given once daily to children with non-central nervous system infections and once or twice daily intravenously to children with meningitis. The mean durations of therapy for children with non-central nervous system infections and with meningitis were 2.4 and 4.6 days, respectively. No child enrolled in this study was readmitted to the hospital for medical or social reasons. Probable complications of treatment included diarrhea in 13% of children with meningitis and in 6% of children with non-central nervous system infections. One child with meningitis developed pseudomembranous colitis. For children who are infected with bacteria that are highly susceptible to ceftriaxone, single daily dose outpatient therapy is a reasonable option for management if a good clinical response to initial treatment is demonstrated and the risks of complications of the disease process are negligible.