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Published on: March 31, 2022
Sequential Intravenous-Oral Therapy for Pediatric Streptococcus anginosus Intracranial Infections
Daniel S Dodson1,2, Heather R Heizer2, James T Gaensbauer2,3
1Section of Pediatric Infectious Diseases, Department of Pediatrics, University of California, Davis, Sacramento, California, USA.
Insights
Levofloxacin-based oral therapy is effective for pediatric intracranial infections caused by the Streptococcus anginosus group. Early transition to oral antibiotics is feasible for less severe cases, reducing central catheter risks.
Area of Science:
- Pediatric Infectious Diseases
- Neuro-Infectious Diseases
- Antimicrobial Stewardship
Background:
- The Streptococcus anginosus group frequently causes pediatric intracranial infections.
- Treatment guidelines, particularly for oral antibiotic therapy, remain undefined for these infections.
Purpose of the Study:
- To evaluate the safety and efficacy of transitioning pediatric patients with Streptococcus anginosus group intracranial infections to oral antibiotic therapy.
- To identify factors influencing the early transition to oral therapy.
Main Methods:
- Retrospective review of 107 pediatric patients with Streptococcus anginosus group pyogenic intracranial infections (2004-2019).
- Analysis of patients transitioned to exclusive oral therapy, focusing on levofloxacin-based regimens.
- Primary endpoint: infection worsening requiring intravenous antibiotics or further surgery post-oral transition.
Main Results:
- 61 of 107 patients were transitioned to oral therapy after a median of 37 days of intravenous treatment, primarily with levofloxacin.
- Only one treatment failure occurred in a patient who did not fill their prescription.
- Early oral transition was more common in epidural infections; parenchymal infections, bacteremia, and higher inflammatory markers were associated with delayed transition.
- Central catheter complications contributed to 56% of oral transitions.
Conclusions:
- Levofloxacin-based oral regimens are effective and well-tolerated for treating Streptococcus anginosus group intracranial infections in children.
- Patients with less severe infections are more likely candidates for early oral transition.
- Establishing clear criteria for oral antibiotic transition is crucial to minimize risks associated with prolonged central catheter use.
Background:
Streptococcus anginosus group is a common cause of pediatric intracranial infections but treatment recommendations, including use of oral therapy, are poorly defined.
Methods:
We performed a retrospective review from 2004 to 2019 of all patients with S anginosus group pyogenic intracranial infections at Children's Hospital Colorado, highlighting patients transitioned to oral therapy. The primary endpoint was worsening infection necessitating intravenous antibiotics or a source control procedure after transition to oral therapy.
Results:
Of 107 patients with S anginosus intracranial infections, 61 were transitioned to exclusive oral therapy after a median intravenous duration of 37 days, overwhelmingly with a levofloxacin-based regimen. Only 1 treatment failure was noted in a patient who did not fill their prescription. Patients with epidural infections were more likely to be transitioned to oral therapy within the first 28 days of treatment (defined as "early"). Patients with parenchymal infections, bacteremia, co-pathogens, higher inflammatory markers, and requiring >1 source control procedure were less likely to be transitioned early to oral therapy. Complications of a central catheter and/or intravenous medications contributed to 56% of oral transitions.
Conclusions:
Levofloxacin-based oral regimens were effective and well tolerated. Patients with less severe infections were more likely to be transitioned early to oral therapy. Criteria for transitioning patients to oral antibiotics for intracranial infections should be established to minimize risks inherent with central catheters.
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