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

Elena Chiappini, Elena Serrano, Luisa Galli, Alberto Villani, Andrzej Krzysztofiak and Italian Paediatric Collaborative Osteomyelitis Study Group
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Elena Chiappini: Paediatric Infectious Disease Unit, Meyer Children’s University Hospital, Department of Health Sciences, University of Florence, 50100 Lorence, Italy
Elena Serrano: Paediatric Infectious Disease Unit, Meyer Children’s University Hospital, Department of Health Sciences, University of Florence, 50100 Lorence, Italy
Luisa Galli: Paediatric Infectious Disease Unit, Meyer Children’s University Hospital, Department of Health Sciences, University of Florence, 50100 Lorence, Italy
Alberto Villani: Pediatric and Infectious Diseases Unit, Academic Department, Bambino Gesù Pediatric Hospital, 00146 Rome, Italy
Andrzej Krzysztofiak: Pediatric and Infectious Diseases Unit, Academic Department, Bambino Gesù Pediatric Hospital, 00146 Rome, Italy
Italian Paediatric Collaborative Osteomyelitis Study Group: Members of the Italian Paediatric Collaborative Osteomyelitis Study Group: Luisa Abbagnato (Como); Samantha Bosis (Milano); Grazia Bossi (Pavia); Fabio Cardinale (Bari); Elio Castagnola (Genova); Salvatore Cazzato (Ancona); Liviana Da Dalt (Padova); Sofia D’Elios (Pisa); Icilio Dodi (Parma): Daniele Donà (Padova); Susanna Esposito (Perugia); Susanna Falorni (Grosseto); Silvia Fasoli (Mantova); Enrico Felici (Alessandria); Romina Gallizzi (Messina); Silvia Garazzino (Torino); Maria Rita Govoni (Ferrara); Francesca Landi (Genova); Marcello Lanari (Bologna); Giuseppe Losurdo (Genova); Andrea Lo Vecchio (Napoli); Paola Marchisio (Milano); Flora Marino (Rovigo); Alberto Martelli (Garbagnate Milanese); Pasqua Massagli (Bari); Antonella Meini (Brescia); Alessandra Meneghel (Vicenza); Chiara Minotti (Padova); Gregorio Paolo Milani (Milano); Alma Nunzia Olivieri (Napoli); Luca Pierantoni (Bologna); Diego Peroni (Pisa); Roberta Ponti (Udine); Simone Rugolotto (Rovigo); Paola Serraino (Alessandria); Simone Sferrazza Papa (Chieti); Monica Sprocati (Ferrara); Camilla Totaro (Bologna); Gianluca Vergine (Rimini); Alberto Verrotti (L’Aquila).

IJERPH, 2019, vol. 16, issue 19, 1-8

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.

Keywords: acute hematogenous osteomyelitis; children; antibiotic (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2019
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