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Banu Kumar, M.D.

January 15, 2015

After reviewing the histories of more than 2,000 American children who were treated with antibiotics for bone infections, a national team of pediatric researchers has come up with a surprising finding that could change the way kids receive the drugs in the future.

The large study found that children who were discharged home with oral antibiotics did just as well in overcoming their bone infections as those who were sent home on intravenous antibiotics.

“This very large clinical trial shows that oral antibiotics also cause significantly fewer complications and that there is no advantage of the more invasive prolonged intravenous therapy. Based on these very hopeful findings, clinicians who treat pediatric bone infections may want to reconsider prescribing intravenous delivery of antibiotics for patients who are being sent home for extended drug therapy,” said Banu Kumar, M.D., Children’s Hospital of Michigan chief of Pediatric Hospital Medicine and assistant professor of Pediatrics for the Wayne State University School of Medicine. Dr. Kumar led the Children’s Hospital of Michigan group participating in the study.

Published last month in the Journal of the American Medical Association Pediatrics, the results of the study (http://archpedi.jamanetwork.com/article.aspx?articleid=2022276) seem likely to challenge the long-held belief that intravenous-delivered antibiotics are more effective than pills in combating bone infections in children.

The analysis of medication records among 2,060 children at 36 U.S. hospitals also found that 15 percent of the children who received antibiotics intravenously through a peripherally inserted central catheter developed complications that later sent them back to an emergency room or required further hospitalization.

The potentially significant implications of these findings were strongly underlined in an accompanying Journal editorial that noted that on the basis of the study, “Clinicians should strongly consider transition to oral antibiotic therapy at the time of discharge for the treatment of acute osteomyelitis in otherwise healthy children.”

The study also noted that the “gravity” of the complications that can result from IV antibiotics delivery – including bloodstream infection, thromboembolism and line breakage – warrants careful reassessment by clinicians of the longtime presumption that intravenous antibiotics are just as safe as the oral version.

Dr. Kumar said the results might eventually help to spare children with bone infections the discomfort and health risks that sometimes accompany intravenous delivery of antibiotics.

“The typical course of treatment for these children is anywhere from six to 12 weeks,” Dr. Kumar said, “and that means they have to live 24/7 with a peripherally inserted central catheter inserted into their arms. It also means that their caregivers have to be trained to do the dosing two or three times a day, often for several months. Given the obvious discomfort, anxiety and risk of infection that can be part of the intravenous procedures, the possibility that we could get the same effectiveness from an orally delivered antibiotic is quite promising. Based on these very hopeful findings, clinicians who treat pediatric bone infections may want to reconsider prescribing intravenous delivery of antibiotics for patients who are being sent home for extended drug therapy.”

Dr. Kumar added that the findings are a “compelling example of how good research can improve medical care. A study like this gives us enormous hope, because it shows how the clinicians and researchers at the Children’s Hospital of Michigan are constantly striving to make standard care more tolerable and safer for kids. At the end of the day, research is an important key to the best care. We need more of these kinds of studies to show there are better ways to care for kids. Children don’t like to be poked and children don’t like to be hurt – and if there are things we can do more effectively, more safely, why not?”

Steven Lipshultz, M.D., chair of Pediatrics for the Wayne State University School of Medicine and pediatrician-in-chief at Children’s Hospital of Michigan, said he was greatly encouraged by the study, which has the potential to provide “significant cost savings” as well as improved care for pediatric patients.

“Dr. Kumar and the other researchers really hit it out of the park with this comparative effectiveness study,” Dr. Lipshultz said.  “What’s exciting for all of us at the Children’s Hospital of Michigan is to know that for the past three years or so we’ve been using this (form of oral therapy) for bone infections as part of the study, which means that we’ve been providing better care for these patients. Based on this study, that has demonstrated that in the absence of data supporting that long-term intravenous antibiotics enhance clinical outcomes when compared with oral therapy, our practice of transitioning otherwise healthy children with acute osteomyelitis to oral antibiotic therapy at the time of discharge to avoid peripherally inserted central catheter-associated complications is both right for the patient and the right thing to do. At the Children’s Hospital of Michigan, we’re doing our best every single day to connect the very latest research to clinical care so that our patients can benefit as much as possible. As Dr. Kumar and her colleagues around the country have demonstrated in this important study, children benefit most when their treatment is informed by the very latest, cutting-edge research. This is an example of how we use practice-based evidence to achieve the very best outcomes for our patients by implementing evidence-based practice.”

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