Editorial
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Pediatr. Aug 8, 2016; 5(3): 244-250
Published online Aug 8, 2016. doi: 10.5409/wjcp.v5.i3.244
Transitioning antimicrobials from intravenous to oral in pediatric acute uncomplicated osteomyelitis
Nathan Batchelder, Tsz-Yin So
Nathan Batchelder, Tsz-Yin So, Department of Pharmacy, Moses H. Cone Memorial Hospital, Greensboro, NC 27401, United States
Author contributions: Batchelder N and So TY contributed to the content, write up and design of this paper.
Conflict-of-interest statement: Batchelder N and So TY declare no conflict of interest related to this publication.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Tsz-Yin So, BCPS, PharmD, Pediatric Clinical Pharmacist, Department of Pharmacy, Moses H. Cone Memorial Hospital, 1200 N. Elm Street, Greensboro, NC 27401, United States. jeremy.so@conehealth.com
Telephone: +1-336-8326166 Fax: +1-336-8327198
Received: March 1, 2016
Peer-review started: March 1, 2016
First decision: March 22, 2016
Revised: April 5, 2016
Accepted: April 21, 2016
Article in press: April 22, 2016
Published online: August 8, 2016
Processing time: 159 Days and 18.8 Hours
Abstract

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.

Keywords: Antimicrobials; C-reactive protein; Intravenous; Oral; Osteomyelitis; Pediatrics

Core tip: When is an appropriate time to switch to oral antibiotics is a challenging question surrounding the treatment of acute uncomplicated osteomyelitis in pediatrics. With improvements in disease management and antibiotic therapy, the standard of care is progressing to a shorter duration of intravenous antibiotics and transitioning to oral therapy for the rest of the treatment course. This review aims to evaluate the current literature in order to help clinicians make sound decisions on when and how to transition from intravenous antibiotics to oral therapy in pediatric patients with acute uncomplicated osteomyelitis.