Kam April J, Leal Jenine, Freedman Stephen B
Division of Paediatric Emergency Medicine, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Pediatr Emerg Care. 2010 Mar;26(3):171-6. doi: 10.1097/PEC.0b013e3181d1de08.
The administration of 1 to 2 doses of intravenous (IV) antibiotics in the emergency department (ED) followed by discharge on oral antibiotics has become a treatment option for children with cellulitis, despite an absence of evidence supporting this practice. The objective of this study was to determine the failure rate of ED short-course IV antibiotic therapy (IV-short course).
This retrospective study included children aged 0 to 18 years diagnosed with cellulitis in a pediatric ED during the 2005 calendar year. Treatment was categorized as (a) discharge on outpatient oral antibiotics, (b) IV-short course, or (c) admission for IV antibiotics (IV-admit). Failure was defined by a subsequent visit less than 7 days since the index visit with a change in antibiotic treatment, the administration of IV antibiotics, or hospitalization. A second data abstractor reviewed 10% of the charts to allow calculation of interobserver scores.
There were 321 eligible children, of whom 154 children were treated with oral antibiotics, 85 IV-short course, and 82 IV-admit. A total of 23 patients (7%) met criteria for failure. Compared with IV-admit, the odds ratio of failure among those who received IV-short course was 7.2 (95% confidence interval [CI], 1.6-33.1). Those who received IV-short course were more likely to revisit within 7 days than were children treated with oral antibiotics alone (risk ratio, 2.4; 95% CI, 1.2-4.7); however, revisits were no more frequent than among children in the IV-admit group (risk ratio, 2.8; 95% CI, 0.65-12.1). The total mean duration of hospital stay was significantly less in the IV-short course group compared with the IV-admit group (14.9 vs 118.6 hours; P < 0.001).
Children with cellulitis frequently receive IV antibiotics. Short-course IV antibiotic therapy is associated with a high failure rate and prolonged ED stay compared with those in children treated with oral antibiotics alone. However, their clinical similarity to the IV-admit group, shorter length of hospital stay, but high failure rate mandates further evaluation before widespread adoption.
在急诊科（ED）给予1至2剂静脉注射（IV）抗生素，随后出院并口服抗生素，已成为蜂窝织炎患儿的一种治疗选择，尽管缺乏支持这种做法的证据。本研究的目的是确定急诊科短程静脉抗生素治疗（IV短程）的失败率。
这项回顾性研究纳入了2005年日历年期间在儿科急诊科诊断为蜂窝织炎的0至18岁儿童。治疗分为以下几类：（a）出院后口服抗生素，（b）IV短程，或（c）入院接受静脉抗生素治疗（IV入院）。失败定义为自首次就诊后7天内再次就诊，且抗生素治疗有变化、接受静脉抗生素治疗或住院治疗。另一位数据提取员复查了10%的病历，以计算观察者间评分。
共有321名符合条件的儿童，其中154名儿童接受口服抗生素治疗，85名接受IV短程治疗，82名接受IV入院治疗。共有23名患者（7%）符合失败标准。与IV入院组相比，接受IV短程治疗的患者失败的比值比为7.2（95%置信区间[CI]，1.6 - 33.1）。接受IV短程治疗的患者比仅接受口服抗生素治疗的儿童更有可能在7天内再次就诊（风险比，2.4；95%CI，1.2 - 4.7）；然而，再次就诊的频率并不比IV入院组的儿童更高（风险比，2.8；95%CI，0.65 - 12.1）。与IV入院组相比，IV短程治疗组的总平均住院时间显著缩短（14.9小时对118.6小时；P < 0.001）。
蜂窝织炎患儿经常接受静脉抗生素治疗。与仅接受口服抗生素治疗的儿童相比，短程静脉抗生素治疗的失败率高且急诊停留时间延长。然而，他们与IV入院组的临床相似性、较短的住院时间但高失败率，在广泛采用之前需要进一步评估。
