Premium
Parenteral vs Oral Antibiotics in the Prevention of Serious Bacterial Infections in Children with Streptococcus pneumoniae Occult Bacteremia: A Meta‐analysis
Author(s) -
Rothrock Steven G.,
Green Steven m.,
Harper Marvin B.,
Clark Mark C.,
McIlmail Daniel P.,
Bachur Richard
Publication year - 1998
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1111/j.1553-2712.1998.tb02468.x
Subject(s) - medicine , bacteremia , streptococcus pneumoniae , occult , antibiotics , meningitis , surgery , microbiology and biotechnology , pathology , alternative medicine , biology
.Objective : To determine whether parenteral antibiotics are superior to oral antibiotics in preventing serious bacterial infections in children with Streptococcus pneumoniae occult bacteremia. Methods : Using the MEDLINE database, the English language literature was searched for all publications concerning bacteremia, fever, or Streptococcus pneumoniae from 1966 to January 1, 1997. All nondupli‐cative studies with a series of children with S. pneumoniae occult bacteremia having both orally treated and parenterally treated groups were reviewed. Children were excluded from individual studies if at the time of their initial evaluation they were immuno‐compromised, had a serious bacterial infection, underwent a lumbar puncture, or did not receive antibiotics. Results : Only 4 studies met study criteria. From these studies, 511 total cases of S. pneumoniae occult bacteremia were identified. Ten of 290 (3.4%) in the oral group and 5 of 221 (2.3%) in the parenteral antibiotic group developed serious bacterial infections (pooled p‐value = 0.467, pooled OR = 1.48; 95% CI, 0.5–4.3). Two patients in the oral group (0.7%) and 2 patients in the parenteral group (0.9%) developed meningitis (pooled p‐value = 0.699, pooled OR = 0.67; 95% CI, 0.1–5.1). Conclusion : The rates of serious bacterial infections and meningitis did not differ between children who were treated with oral and parenteral antibiotics. The extremely low rate of complications observed in both groups suggests no clinically significant difference between therapies. A study with > 7,500 bacteremic children (or >300,000 febrile children) would be needed to have 80% power to prove parenteral antibiotics are superior to oral antibiotics in preventing serious bacterial infections.