Practical Issues in Early Switching from Intravenous to Oral Antibiotic Therapy in Children with Uncomplicated Acute Hematogenous Osteomyelitis: Results from an Italian Survey

Italian Paediatric Collaborative Osteomyelitis Study Group

Research output: Contribution to journalArticle

Abstract

Background: The European Society of Pediatric Infectious Diseases (ESPID) guidelines for acute hematogenous osteomyelitis (AHOM) have been published recently. In uncomplicated cases, an early (2-4 days) switch to oral empirical therapy, preferentially with flucloxacillin, is recommended in low methicillin-resistant Staphylococcus aureus settings. We conducted a survey with the aim of evaluating the behaviors of Italian pediatricians at this regard. Methods: An open-ended questionnaire investigating the empiric therapy adopted in uncomplicated AHOM children according to age was sent by email to 31 Italian pediatric clinics taking care of children with infectious diseases, and results were analyzed. Results: The preferred intravenous (IV) regimen was a penicillin plus an aminoglycoside (n = 10; 32.3%) in children aged <3 months, and a combination of a third-generation cephalosporin plus oxacillin (n = 7; 22.6%), or oxacillin alone (n = 6; 19.4%) in those ≥3 months. In every age class, amoxicillin-clavulanate was the first-choice oral antibiotic. Other antibiotics largely used orally included clindamycin, rifampicin, and trimethoprim/sulfamethoxazole. Flucloxacillin was never prescribed. Only 3 centers switched to oral therapy within 7 days in children ≥3 months of age. The most commonly reported reason influencing the time to switch to oral therapy concerned caregivers' adherence to oral therapy. Conclusion: Adherence to guidelines was poor, and early transition to oral therapy in the clinical practice was rarely adopted. Given the large use of potentially effective, but poorly studied, oral antibiotics such as amoxicillin/clavulanate, trimethoprim/sulfamethoxazole, and rifampicin, our data may stimulate further studies of this regard.

Original languageEnglish
JournalInternational Journal of Environmental Research and Public Health
Volume16
Issue number19
DOIs
Publication statusPublished - Sep 23 2019

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Osteomyelitis
Anti-Bacterial Agents
Floxacillin
Oxacillin
Clavulanic Acid
Amoxicillin
Sulfamethoxazole Drug Combination Trimethoprim
Rifampin
Communicable Diseases
Therapeutics
Pediatrics
Guideline Adherence
Clindamycin
Aminoglycosides
Cephalosporins
Methicillin-Resistant Staphylococcus aureus
Child Care
Penicillins
Caregivers
Surveys and Questionnaires

Cite this

@article{0e32e4c7ae874809a92c96adf9cb1571,
title = "Practical Issues in Early Switching from Intravenous to Oral Antibiotic Therapy in Children with Uncomplicated Acute Hematogenous Osteomyelitis: Results from an Italian Survey",
abstract = "Background: The European Society of Pediatric Infectious Diseases (ESPID) guidelines for acute hematogenous osteomyelitis (AHOM) have been published recently. In uncomplicated cases, an early (2-4 days) switch to oral empirical therapy, preferentially with flucloxacillin, is recommended in low methicillin-resistant Staphylococcus aureus settings. We conducted a survey with the aim of evaluating the behaviors of Italian pediatricians at this regard. Methods: An open-ended questionnaire investigating the empiric therapy adopted in uncomplicated AHOM children according to age was sent by email to 31 Italian pediatric clinics taking care of children with infectious diseases, and results were analyzed. Results: The preferred intravenous (IV) regimen was a penicillin plus an aminoglycoside (n = 10; 32.3{\%}) in children aged <3 months, and a combination of a third-generation cephalosporin plus oxacillin (n = 7; 22.6{\%}), or oxacillin alone (n = 6; 19.4{\%}) in those ≥3 months. In every age class, amoxicillin-clavulanate was the first-choice oral antibiotic. Other antibiotics largely used orally included clindamycin, rifampicin, and trimethoprim/sulfamethoxazole. Flucloxacillin was never prescribed. Only 3 centers switched to oral therapy within 7 days in children ≥3 months of age. The most commonly reported reason influencing the time to switch to oral therapy concerned caregivers' adherence to oral therapy. Conclusion: Adherence to guidelines was poor, and early transition to oral therapy in the clinical practice was rarely adopted. Given the large use of potentially effective, but poorly studied, oral antibiotics such as amoxicillin/clavulanate, trimethoprim/sulfamethoxazole, and rifampicin, our data may stimulate further studies of this regard.",
author = "{Italian Paediatric Collaborative Osteomyelitis Study Group} and Elena Chiappini and Elena Serrano and Luisa Galli and Alberto Villani and Andrzej Krzysztofiak",
year = "2019",
month = "9",
day = "23",
doi = "10.3390/ijerph16193557",
language = "English",
volume = "16",
journal = "International Journal of Environmental Research and Public Health",
issn = "1661-7827",
publisher = "MDPI AG",
number = "19",

}

TY - JOUR

T1 - Practical Issues in Early Switching from Intravenous to Oral Antibiotic Therapy in Children with Uncomplicated Acute Hematogenous Osteomyelitis

T2 - Results from an Italian Survey

AU - Italian Paediatric Collaborative Osteomyelitis Study Group

AU - Chiappini, Elena

AU - Serrano, Elena

AU - Galli, Luisa

AU - Villani, Alberto

AU - Krzysztofiak, Andrzej

PY - 2019/9/23

Y1 - 2019/9/23

N2 - Background: The European Society of Pediatric Infectious Diseases (ESPID) guidelines for acute hematogenous osteomyelitis (AHOM) have been published recently. In uncomplicated cases, an early (2-4 days) switch to oral empirical therapy, preferentially with flucloxacillin, is recommended in low methicillin-resistant Staphylococcus aureus settings. We conducted a survey with the aim of evaluating the behaviors of Italian pediatricians at this regard. Methods: An open-ended questionnaire investigating the empiric therapy adopted in uncomplicated AHOM children according to age was sent by email to 31 Italian pediatric clinics taking care of children with infectious diseases, and results were analyzed. Results: The preferred intravenous (IV) regimen was a penicillin plus an aminoglycoside (n = 10; 32.3%) in children aged <3 months, and a combination of a third-generation cephalosporin plus oxacillin (n = 7; 22.6%), or oxacillin alone (n = 6; 19.4%) in those ≥3 months. In every age class, amoxicillin-clavulanate was the first-choice oral antibiotic. Other antibiotics largely used orally included clindamycin, rifampicin, and trimethoprim/sulfamethoxazole. Flucloxacillin was never prescribed. Only 3 centers switched to oral therapy within 7 days in children ≥3 months of age. The most commonly reported reason influencing the time to switch to oral therapy concerned caregivers' adherence to oral therapy. Conclusion: Adherence to guidelines was poor, and early transition to oral therapy in the clinical practice was rarely adopted. Given the large use of potentially effective, but poorly studied, oral antibiotics such as amoxicillin/clavulanate, trimethoprim/sulfamethoxazole, and rifampicin, our data may stimulate further studies of this regard.

AB - Background: The European Society of Pediatric Infectious Diseases (ESPID) guidelines for acute hematogenous osteomyelitis (AHOM) have been published recently. In uncomplicated cases, an early (2-4 days) switch to oral empirical therapy, preferentially with flucloxacillin, is recommended in low methicillin-resistant Staphylococcus aureus settings. We conducted a survey with the aim of evaluating the behaviors of Italian pediatricians at this regard. Methods: An open-ended questionnaire investigating the empiric therapy adopted in uncomplicated AHOM children according to age was sent by email to 31 Italian pediatric clinics taking care of children with infectious diseases, and results were analyzed. Results: The preferred intravenous (IV) regimen was a penicillin plus an aminoglycoside (n = 10; 32.3%) in children aged <3 months, and a combination of a third-generation cephalosporin plus oxacillin (n = 7; 22.6%), or oxacillin alone (n = 6; 19.4%) in those ≥3 months. In every age class, amoxicillin-clavulanate was the first-choice oral antibiotic. Other antibiotics largely used orally included clindamycin, rifampicin, and trimethoprim/sulfamethoxazole. Flucloxacillin was never prescribed. Only 3 centers switched to oral therapy within 7 days in children ≥3 months of age. The most commonly reported reason influencing the time to switch to oral therapy concerned caregivers' adherence to oral therapy. Conclusion: Adherence to guidelines was poor, and early transition to oral therapy in the clinical practice was rarely adopted. Given the large use of potentially effective, but poorly studied, oral antibiotics such as amoxicillin/clavulanate, trimethoprim/sulfamethoxazole, and rifampicin, our data may stimulate further studies of this regard.

U2 - 10.3390/ijerph16193557

DO - 10.3390/ijerph16193557

M3 - Article

C2 - 31547550

VL - 16

JO - International Journal of Environmental Research and Public Health

JF - International Journal of Environmental Research and Public Health

SN - 1661-7827

IS - 19

ER -