Oral Versus Intravenous Antibiotics for Pediatric Osteoarticular Infection: When and to Whom?

Abstract

Background Osteoarticular infections 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 two groups. Group 1: management with initial intravenous antibiotic therapy. Group 2: patients exclusively treated with oral antibiotics. A comparison between the two 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 ESR/CRP ratio (1.4 IQR 0.6-3.6 vs 3.3 IQR 1.7-5.7, p <0.001) and showed lower rate of fever (63% vs 48.8%; p=0.024). Complications were not found in Group 2. Conclusion 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-3 years of age, appropriate oral tolerance, CRP ≤80 mg/L, ESR/CRP ratio ≥ 0.67, no skin injury, no recent surgery, no cervical spondylodiscitis and no local complications at onset.

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“…Prolonged intravenous antibiotic therapy was not associated with improved outcomes 69 . Paralleling this, the use of an oral-only antibiotic regimen for the management of osteomyelitis appears to be a viable alternative in select patients 70 .…”