Ron Keren, MD, MPH, director of the Center for Pediatric Clinical Effectiveness, was recently awarded nearly two million dollars from the Patient-Centered Outcomes Research Institute to lead a study of treatments for serious bacterial infections in children.

The three-year award will support a project examining whether children who have a serious bacterial infection that requires prolonged antibiotic therapy (greater than one week) do as well taking the antibiotics by mouth as they would if they received them via an intravenous (IV) catheter, specifically a peripherally inserted central catheter, or PICC line.

"These two antibiotic treatment options have major implications for the overall experience of the child, families and caregivers, but there is a lack of real-world evidence on their benefits and drawbacks to help clinicians and patient families make an informed choice," said Dr. Keren.

Unlike regular IV catheters, PICC lines can stay in the body for weeks to months, but they require regular maintenance. A variety of medical equipment is required to use and maintain PICC lines, including infusion pumps, IV antibiotic solutions, dressings, and portable IV poles.

PICC lines also have some risks. They can clot, break, or become dislodged. And because they sit in large blood vessels directly above the heart, any bacteria that are inadvertently introduced into the catheter go directly to the heart and are pumped throughout the body, which can lead to a dangerous infection called sepsis.

Oral antibiotics, on the other hand, are much easier for patients to take and caregivers to manage. However, because oral medications must pass through the digestive system, to have the same efficacy as IV medications oral antibiotics must have high "bioavailability" — the percentage of the drug that reaches the blood. Drugs administered via PICC lines have, by definition, 100 percent bioavailability.

"If we find that the prolonged IV option is no better than the oral route, we think that most families would prefer for their child to take oral antibiotics," Dr. Keren noted. "However, if IV antibiotics are marginally better than oral antibiotics, then that benefit will need to be weighed against any reduction in quality of life and complications that we anticipate with the PICC lines."