Shortened IV Antibiotic Course Works for Uncomplicated Group B Strep

By Reuters Staff

NEW YORK (Reuters Health) - A shorter course of intravenous antibiotics was safe and effective for infants with uncomplicated, late-onset group B Streptococcus (GBS), in a retrospective study.

Prolonged IV antibiotic therapy (10 days) is recommended for treatment of late-onset GBS but this is associated with an increased risk of central line complications. Some clinicians are moving toward shorter IV courses for these patients, despite the recommendations.

Dr. Eric Coon from University of Utah in Salt Lake City and colleagues took a look back at 775 infants aged 4 months or younger who were admitted to children's hospitals from 2000 to 2015 with uncomplicated, late-onset GBS.

The cohort included 612 infants (79%) who received prolonged IV antibiotic therapy and 163 (21%) who received treatment for eight days or less.

As reported online in Pediatrics October 11, infants who received the shortened course were older, more often admitted in later years, and more likely to have a concomitant urinary tract infection.

There was "striking variation" in IV antibiotic duration among hospitals (range: 0% to 67%). No patients were treated with a shortened IV course at 14 hospitals, whereas five hospitals treated more than half of their patients with shortened IV courses, the investigators say.

Overall rates of GBS recurrence were low and not significantly different between the shortened and prolonged IV antibiotic groups (1.8% vs 2.3%). "Treatment failure was rare," whether prolonged or shortened IV antibiotics were used, and did not differ by IV treatment duration, the authors said.

Eight patients (1%) experienced complications due to a peripherally inserted central catheter during their index admission. Seven of these were in the prolonged IV therapy group. Three patients (all from the prolonged IV therapy group) were readmitted to the hospital with a diagnosis code for a PICC complication within 30 days of their index hospital discharge.

Ideally, a randomized trial would be helpful to provide a more definitive answer to the question of effectiveness of shortened versus prolonged IV therapy for treatment of GBS bacteremia. However, that's unlikely to happen given the modest prevalence of GBS disease, the authors note.

In lieu of a controlled trial, their observational data suggest low rates of disease recurrence and treatment failure with a shortened course and reveal that this strategy is being used at some children's hospitals.

The study had no commercial funding and the authors have no relevant disclosures.

SOURCE: https://bit.ly/2NzAkqJ

Pediatrics 2018.

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