Open AccessTransitioning antimicrobials from intravenous to oral in pediatric acute uncomplicated osteomyelitis
Author(s) -
Nathan Batchelder,
Tsz-Yin So
Publication year - 2016
Publication title -
world journal of clinical pediatrics
Language(s) - English
Resource type - Journals
ISSN - 2219-2808
DOI - 10.5409/wjcp.v5.i3.244
Subject(s) - medicine , osteomyelitis , antibiotics , intravenous therapy , regimen , sepsis , antimicrobial , surgery , intensive care medicine , chemistry , organic chemistry , microbiology and biotechnology , biology
Osteomyelitis is a bone infection that requires prolonged antibiotic treatment and potential surgical intervention. If left untreated, acute osteomyelitis can lead to chronic osteomyelitis and overwhelming sepsis. Early treatment is necessary to prevent complications, and the standard of care is progressing to a shorter duration of intravenous (IV) antibiotics and transitioning to oral therapy for the rest of the treatment course. We systematically reviewed the current literature on pediatric patients with acute osteomyelitis to determine when and how to transition to oral antibiotics from a short IV course. Studies have shown that switching to oral after a short course (i.e., 3-7 d) of IV therapy has similar cure rates to continuing long-term IV therapy. Prolonged IV use is also associated with increased risk of complications. Parameters that help guide clinicians on making the switch include a downward trend in fever, improvement in local tenderness, and a normalization in C-reactive protein concentration. Based on the available literature, we recommend transitioning antibiotics to oral after 3-7 d of IV therapy for pediatric patients (except neonates) with acute uncomplicated osteomyelitis if there are signs of clinical improvement, and such regimen should be continued for a total antibiotic duration of four to six weeks.