Oral Versus Intravenous Antibiotics for Pediatric Osteoarticular Infection: When and to Whom?. Issue 9 (27th June 2022)

• Record Type: Journal Article
• Authors: Alcobendas Rueda, Rosa M.; Núñez, Esmeralda; Martín, Laura; Hernández, María Belén; Saavedra-Lozano, Jesús; Udaondo, Clara; Murias, Sara; Remesal, Agustin; Calvo, Cristina
• Other Names: Bustillo Matilde author non-byline.; Lafuente Miguel author non-byline.; Melendo Susana author non-byline.; Vila Jorgina author non-byline.; Clemente Daniel author non-byline.; Sanz Francisco José author non-byline.; Fumadó Victoria author non-byline.; Ríos María author non-byline.; María Méndez author non-byline.; Menasalvas Ana Isabel author non-byline.; García Carmen author non-byline.; Fernández Elisa author non-byline.; Calavia Olga author non-byline.; Guarch Borja author non-byline.; Garrote Elisa author non-byline.; Camacho Marisol author non-byline.; Falcón Lola author non-byline.; Coll María Teresa author non-byline.; Rius Neus author non-byline.; Tagarro Alfredo author non-byline.; Colino Elena author non-byline.; Gavilán César author non-byline.; Díaz Rafael author non-byline.; Vázquez Carmen author non-byline.; Lirola María José author non-byline.; del Pozo María author non-byline.; García Lourdes author non-byline.; Monterde Carla author non-byline.; Figueroa Lucía author non-byline.; Bravo Beatriz author non-byline.; Valle Jose María author non-byline.; Salvador Juan author non-byline.; Moreno Carmen author non-byline.; Bueno María Mercedes author non-byline.; Rivero Irene author non-byline.; López Agustín author non-byline.; García María Jesús author non-byline.; Ranchal Pilar author non-byline.; Pons Sara author non-byline.; Callejas Ignacio author non-byline.; Martínez Leticia author non-byline.; Vázquez Carmen author non-byline.; Domènech Daniel author non-byline.; Ramakers Jan author non-byline.; Caldeiro María Jesús author non-byline.;
• Is Part Of: Pediatric infectious disease journal. Volume 41:Issue 9(2022)
• Page Start: e351
• Page End: e357
• Publication Date: 2022-06-27
• Subjects: arthrocentesis -- children -- Kingella kingae -- oral -- osteoarticular infections -- osteomyelitis -- pediatric -- septic arthritis -- treatment; Communicable diseases in children -- Periodicals; Infection in children -- Periodicals; 618.929
• DOI: 10.1097/INF.0000000000003619
• Languages: English
• ISSNs: 0891-3668

Abstract

Abstract : Background: Osteoarticular infections (OAIs) are typically treated initially with intravenous antibiotics. The objective of this study was to evaluate whether an exclusive oral treatment in selected children may be appropriate. Methods: The Spanish Network of Osteoarticular Infections is a nationwide multicenter registry comprising 37 hospitals in Spain. The registry prospectively includes clinical characteristics and outcome of children with OAI. One of the hospitals from RioPed offers oral treatment to children meeting certain criteria. Patients were classified into 2 groups. Group 1: management with initial intravenous antibiotic therapy. Group 2: patients exclusively treated with oral antibiotics. A comparison between the 2 groups was performed. Results: We compared 893 children who initially received intravenous antibiotics (group 1) with 64 children who received exclusively oral therapy (group 2). Patients from group 2 were younger (33.9 vs. 20.3 months; P = 0.001), had a lower percentage of Staphylococcus aureus (23.3% vs. 3.1%; P < 0.001), a higher proportion of Kingella kingae (12.1% vs. 28.1%; P = 0.001), higher erythrocyte sedimentation rate/C-reactive protein (CRP) ratio (1.4 interquartile range 0.6–3.6 vs. 3.3 interquartile range 1.7–5.7; P < 0.001) and showed lower rate of fever (63% vs. 48.8%; P = 0.024) than in group 1. Complications were not found in group 2. Conclusions: An exclusively oral administration could be a safe option in selected patients with OAI. Low-risk criteria are proposed: good general condition, no underlying disease, 6 months to 3 years old, appropriate oral tolerance, C-reactive protein <80 mg/L, erythrocyte sedimentation rate/C-reactive protein ratio ≥0.67, no skin injury, no recent surgery, no cervical spondylodiscitis and no local complications at onset.