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Intravenous Antibiotic Treatment With Oral Relay in Pediatric Intracranial Abscesses: A 20-Year Descriptive
Audrey Lassalle1, Eloise Baudou1, Caroline Viard2
1From the Pediatric Neurology Department.
Insights
A 3-week intravenous antibiotic course followed by oral antibiotics may suffice for pediatric brain abscesses. Factors like abscess presence and seizures indicate a need for longer treatment durations.
Area of Science:
- Pediatric Neurology
- Infectious Diseases
- Neurosurgery
Background:
- Brain abscesses and empyema are rare but serious intracranial infections.
- Current management protocols for brain abscesses lack consensus, particularly regarding antibiotic duration.
- This study addresses the need for evidence-based antibiotic treatment guidelines for pediatric brain abscesses.
Purpose of the Study:
- To determine the optimal duration of antibiotic therapy for pediatric brain abscesses and empyema.
- To identify clinical, radiological, and therapeutic factors associated with prolonged intravenous antibiotic treatment (>3 weeks).
Main Methods:
- Retrospective analysis of 70 pediatric patients with brain abscess/empyema treated between 2002 and 2022.
- Data collected included clinical, biological, radiological, and therapeutic characteristics, and sequelae.
- Univariate analysis compared outcomes between patients receiving ≤3 weeks vs. >3 weeks of intravenous antibiotics.
Main Results:
- The median total antibiotic duration was 42 days, with 22.5 days of intravenous therapy.
- Factors predicting prolonged intravenous therapy included abscess presence, seizures/neurological deficits at diagnosis, and neurosurgical intervention.
- Significant cognitive sequelae were associated with extended treatment periods.
Conclusions:
- A 3-week intravenous antibiotic regimen, followed by 3 weeks of oral antibiotics, appears adequate for many pediatric brain abscess cases.
- Complicated brain abscesses necessitate extended antibiotic courses.
- This study provides valuable data for refining antibiotic treatment protocols in pediatric neurosurgery and infectious disease management.
Background:
Brain abscesses/empyema are suppurated intra- or peri-cerebral accumulations. The incidence is low, and mortality is decreasing, but their management remains nonconsensual. Our aim was to describe the duration of antibiotic therapy required to cure our infected population and to identify factors associated with prolonged intravenous antibiotic therapy lasting more than 3 weeks, according to our local protocol.
Methods:
Pediatric patients with cerebral abscess/empyema treated at Toulouse University Hospital between January 2002 and October 2022 were included. Clinical, biologic, radiologic and therapeutic characteristics, as well as the presence of sequelae, were recorded. A univariate analysis was performed to compare the "≤3 weeks intravenous" group with the ">3 weeks intravenous" group.
Results:
Seventy patients were included. One patient died quickly of cerebellar involvement. There were no recurrences. The median total duration of antibiotic treatment was 42 days (42; 59), and 22.5 days for intravenous antibiotic therapy alone (21; 36). Factors associated with a longer period than 3 weeks of intravenous antibiotic treatment were: the presence of an abscess, epileptic seizure/neurologic deficit at diagnosis and a neurosurgical procedure. Significant cognitive sequelae were also associated with an extended period of treatment. Persistent contrast enhancement at the time of switching and of discontinuing antibiotic therapy was not associated with an extended period of antibiotic therapy.
Conclusions:
This study suggested that a 3-week course of intravenous antibiotic therapy combined with a 3-week course of oral antibiotics is sufficient for full recovery in many children with brain abscesses or empyema. Complicated cases require a more extended period of antibiotic therapy.
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