Discharge Home After Transition to Oral Antibiotics: No Jeopardy

Transitioning children from intravenous to enteral antibiotics is a daily occurrence for providers caring for children in hospitals. These children have clinically improved but require additional days of medication to complete an effective course of therapy. Some clinicians make the change to enteral antibiotics and discharge the child immediately, whereas others watch the child in the hospital setting on the enteral antibiotic therapy for a day or more. In their study, Stromberg et al¹ suggest that prolonged observation is not the national norm, that the practice of observation after transitioning therapy has wide variability nationally, and that observation after transitioning therapy is likely unnecessary for children with skin and soft tissue infections (SSTIs). The authors’ findings beg the question: When do you deviate from the norm?

The Infectious Diseases Society of America’s SSTI guidelines recommend cephalexin or clindamycin for cases of SSTI in which the child is stable and does not have bacteremia or intravascular infection; but vancomycin is listed as first-line therapy for complicated SSTIs.² In the current study, the authors found that despite the fact that children in this cohort were considered to have “uncomplicated” SSTI, ∼20% of these children received vancomycin during their hospital stay before transitioning to oral therapy. Vancomycin use in SSTIs can add significant cost to a hospitalization,³ entails additional diagnostic testing for safety and therapeutic monitoring, and adds risk of nephrotoxicity⁴. This study builds on previous …