PIVOT: IV vs Oral antibiotics for Pneumonia. Journal Club April 2012 Chris Edwards. Introduction. What is your clinical practise with moderate to severe pneumonia? “48 hours IVs and then home on orals if culture negative.” But this doesn’t make sense …. Plan. PICO Search Result
Journal Club April 2012
What is your clinical practise with moderate to severe pneumonia?
“48 hours IVs and then home on orals if culture negative.”
But this doesn’t make sense ….
P- children with pneumonia
I – Oral antibiotics
C – IV antibiotics
O- time to recovery/time in hospital
“pneumonia AND antibiotics”
Children (0-18 years)
Then looked for developed world(few) rather than developing world (lots)
Comparison of oral amoxicillin and intravenous benzylpenicillin for community acquired pneumonia in children(PIVOT trial): a multicentre pragmatic randomised controlled equivalence trial
M Atkinson, M Lakhanpaul, A Smyth, H Vyas, V Weston, J Sithole, V Owen, K Halliday, H Sammons, J Crane, N Guntupalli, L Walton, T Ninan, A Morjaria, T Stephenson
Thorax 2007;62:1102–1106. doi: 10.1136/thx.2006.074906
“A study was undertaken to ascertain whether therapeutic equivalence exists for treatment of community acquired pneumonia by the oral and IV route.”
“A block randomisation sequence stratified by centre was produced using a random number generator. The sequence was accessed via the internet, therefore allowing concealment of allocation.
Children were randomly assigned to oral amoxicillin (chosen in preference to oral penicillin owing to the superior absorption and palatability) or IV benzyl penicillin.”
So not double blind.
Could have cannulated all, given placebo IV to the oral group and oral placebo to the IV group…
Children in the IV group were changed to oral amoxicillin on discharge or sooner if the clinical team considered their improvement warranted this.
Both groups completed a 1-week course of antibiotics in total.
IV group more likely to require another antibiotic / rescue medication.
?Does this mean there was an inherent difference in the two groups?
For the primary outcome measure, all p values are for equivalence. Therefore, a p value of ,0.05 indicates that the null hypothesis (a difference of .20% exists between the two treatments) has been disproved.
Yes – Nottingham isn’t that far away (especially now they widened the M1).
Oral antibiotics appear to be equivalent to IV antibiotics for pneumonia
Pts on IV antibiotics appear to have more complications
Would you encourage the team to change practice in AAU?