Mythbusting

Shocker! Parents may prefer PO to IV treatement.

FOR MENINGITIS!

One dogma that particularly sticks in my craw is that IV antibiotics are somehow mythically better than their PO counterparts. This is one that clinicians continue to perpetuate despite quite a bit of evidence to the contrary, and sometimes under the guise that “its what the patients want.”

Well, this paper from Brown University in Rhode Island (home of Del’s Lemonade and the Awful Awful) have sought to dispel.

For 3 months, the authors surveyed 102 consecutive parents of children who were not undergoing evaluation for potential Lyme disease and who were being seen in a pediatric ED. The reason for choosing Lyme disease as their hypothetical case is that the great state of Rhode Island is an are endemic to Lyme disease, and children with Lyme meningitis are often treated with intravenous ceftriaxone although oral doxycycline may be effective.

The parents were surveyed after observing a 9 minute video describing a hypothetical Lyme meningitis treatment trial (PO doxy vs IV ceftriaxone), and 84 of 102 parents (82%) would consent to their child participating (!). Even more impressive was that 37% of parents would accept 2 additional days of symptoms with oral meds even if intravenous treatment hastened symptom resolution (44% would accept one additional day symptoms). When told that there was likely equivalence, 47% would prefer doxycycline treatment, 24% thought it would be equivalent, and 29% still preferred IV treatments – with no differences in likelihood of choice based on age, ethnicity, education or knowledge of lyme disease. There was a weak correlation between perceived efficacy and tx preference, while there was a moderate correlation between perceived safety and treatment preference.

Basically, explain that about a third of patients have issues with IV antibiotics or PICCs (more diarrhea, allergic reactions, more DVTs, etc – not to mention bigger bills from VNS services, inpatient stays, etc), and you’ve got ~70% chance that the parents would be ok with outpatient treatment.

Understandably, as the authors put it, “the hypothetical nature of this study may overestimate the proportion of parents who would consent in an actual trial” – but it provides great food for thought to at least consider having the conversation with parents on your next shift when you as the clinician are on the fence of stay or go.

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