In the per-protocol analysis, this translated into an overall cost difference of AUS$122,104 (US$87,026) in favor of the home group.
“While most physicians accept that home is psychologically better for children, the lack of evidence for efficacy and safety is frequently cited as underpinning their reluctance to manage children outside the hospital environment, without the reassurance of 24-hour monitoring,” Dr. Bryant said. “Here is that robust evidence for the efficacy and safety of home management of moderate/severe cellulitis directly from the emergency department. We hope physicians will use it for their patients and advocate for resources to provide this type of care.”
“Although this trial specifically studied the medical condition cellulitis, it is likely that other infections in children can be treated in the same way, for example, urinary tract infections,” she said. “We would welcome research in other types of infections, and since location of treatment is such a dichotomous decision, this should be in the form of randomized controlled trials to provide the robustness of evidence required for physicians to change their practice.”
Dr. Nathan M. Krah of the University of Utah in Salt Lake City, who co-authored a linked editorial, told Reuters Health by email, “It’s interesting that almost all outcomes measured in this study favor OPAT. Patient satisfaction scores and costs both strongly favor outpatient treatment. The only outcome that favored hospitalization is the length of overall treatment. Overall, OPAT was not only noninferior, but it performed better than hospitalization in most primary and secondary outcomes.”
“OPAT can be considered as an alternative to continued hospitalization for pediatric patients requiring intravenous therapy under certain circumstances,” he said.
Dr. Krah added, “The other important point is that there is a growing body of evidence that for many infections traditionally treated with OPAT, treatment with oral therapy results in equivalent clinical outcomes at lower costs, with fewer side effects and less burden for patients and caregivers.”
Dr. Melanie Duval from Montreal Children’s Hospital, in Canada, who recently reported that OPAT with daily reassessment by a physician is a safe alternative in some children with periorbital cellulitis, told Reuters Health by email, “I strongly believe that for selected patients this is an excellent alternative to hospitalization, as it is a much easier experience for children and families to be treated at home, as opposed to being hospitalized, and it leads to significant cost savings with excellent clinical outcomes comparable to that of hospitalization.”