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Article

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

1
Paediatric Infectious Disease Unit, Meyer Children’s University Hospital, Department of Health Sciences, University of Florence, 50100 Lorence, Italy
2
Pediatric and Infectious Diseases Unit, Academic Department, Bambino Gesù Pediatric Hospital, 00146 Rome, Italy
*
Author to whom correspondence should be addressed.
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).
Int. J. Environ. Res. Public Health 2019, 16(19), 3557; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph16193557
Received: 16 August 2019 / Revised: 10 September 2019 / Accepted: 12 September 2019 / Published: 23 September 2019
(This article belongs to the Section Children's Health)
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. View Full-Text
Keywords: acute hematogenous osteomyelitis; children; antibiotic acute hematogenous osteomyelitis; children; antibiotic
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MDPI and ACS Style

Chiappini, E.; Serrano, E.; Galli, L.; Villani, A.; Krzysztofiak, A.; Italian Paediatric Collaborative Osteomyelitis Study Group. Practical Issues in Early Switching from Intravenous to Oral Antibiotic Therapy in Children with Uncomplicated Acute Hematogenous Osteomyelitis: Results from an Italian Survey. Int. J. Environ. Res. Public Health 2019, 16, 3557. https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph16193557

AMA Style

Chiappini E, Serrano E, Galli L, Villani A, Krzysztofiak A, Italian Paediatric Collaborative Osteomyelitis Study Group. Practical Issues in Early Switching from Intravenous to Oral Antibiotic Therapy in Children with Uncomplicated Acute Hematogenous Osteomyelitis: Results from an Italian Survey. International Journal of Environmental Research and Public Health. 2019; 16(19):3557. https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph16193557

Chicago/Turabian Style

Chiappini, Elena, Elena Serrano, Luisa Galli, Alberto Villani, Andrzej Krzysztofiak, and Italian Paediatric Collaborative Osteomyelitis Study Group. 2019. "Practical Issues in Early Switching from Intravenous to Oral Antibiotic Therapy in Children with Uncomplicated Acute Hematogenous Osteomyelitis: Results from an Italian Survey" International Journal of Environmental Research and Public Health 16, no. 19: 3557. https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph16193557

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