Outpatient parenteral antimicrobial therapy (OPAT) is noninferior to in-hospital intravenous therapy for children with cellulitis, according to results from the CHOICE trial.
“We believe that this is a game-changer for this condition, because this trial provides the much needed robust evidence that OPAT is as good as hospital treatment for moderate/severe cellulitis and is associated with better quality of life, while reducing institutional costs,” Dr. Penelope A. Bryant of the University of Melbourne and The Royal Children’s Hospital, in Australia, told Reuters Health by email.
OPAT is an accepted approach in numerous settings, but evidence supporting its use in children is limited.
Dr. Bryant’s team compared the efficacy and safety of home-based treatment with intravenous ceftriaxone with that of standard hospital treatment with intravenous flucloxacillin in the first randomized controlled trial of OPAT for admission avoidance in children with moderate to severe cellulitis.
The study included 188 children (93 in the home group and 95 in the hospital group) whose median follow-up was seven days.
Treatment failure was defined as no clinical improvement or occurrence of an adverse event resulting in a change of initial empiric antibiotics within 48 hours of administration of the first antibiotic dose in the emergency department. This occurred in two (2 percent) of the children in the home group versus seven (7 percent) of the children in the hospital group, a difference that satisfied the prespecified criterion for noninferiority.
Adverse event rates were significantly lower in the home group (2 percent) than in the hospital group (11 percent), the team reports in The Lancet Infectious Diseases, online March 7.
Length of stay in the emergency department and rate of re-catheterization were lower in the home group, whereas duration of intravenous antibiotic therapy and medical care were shorter in the hospital group.
There was no difference between the groups in the proportion of patients who acquired extended-spectrum-beta-lactamase (ESBL)-producing bacteria or C. difficile at seven to 14 days or three months after intravenous antibiotic therapy, and no patient in either group acquired vancomycin-resistant enterococcus (VRE) or methicillin-resistant Staphylococcus aureus (MRSA) infection.
More parents in the home group (69 out of 73, 95 percent) than in the hospital group (45 out of 62, 73 percent) rated the experience of care as very good.
Including the cost of hospital stay for the two patients in the home group who had treatment failure and required in-hospital treatment, the mean cost of treatment was AUS$1,463 (US$1,043) per patient per day for the home group and AUS$2,594 (US$1,849) per patient per day for the hospital group.