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Intracranial Suppurative Infections in Children: Oral Antibiotic Switch and Corticosteroid Use in a Multicenter

Fuensanta Guerrero-Del-Cueto1,2,3, Lola Falcón-Neyra4, Leticia Martínez-Campos5

  • 1From the IBIMA Plataforma Bionand, Instituto de Investigación Biomédica de Málaga, Málaga, Spain.

The Pediatric Infectious Disease Journal
|August 18, 2026
PubMed

Insights

Pediatric intracranial suppurative infections are serious conditions with varied outcomes. Some children can safely switch to oral antibiotics, but standardized protocols are needed to improve results and reduce long-term effects.

Area of Science:

  • Pediatric Infectious Diseases
  • Pediatric Neurology
  • Clinical Microbiology

Background:

  • Intracranial suppurative infections (ISIs) like brain abscesses and empyemas are rare but severe pediatric conditions.
  • These infections present challenges due to diagnostic delays, potential for neurological damage, and inconsistent treatment approaches.
  • Limited evidence exists for optimal antibiotic duration, administration route, and corticosteroid use in pediatric ISIs.

Purpose of the Study:

  • To analyze clinical characteristics, management strategies, and outcomes of pediatric intracranial suppurative infections.
  • To identify factors associated with treatment success and long-term neurological sequelae in affected children.
  • To evaluate the safety and efficacy of transitioning from intravenous to oral antibiotic therapy.

Main Methods:

  • A retrospective multicenter study included 75 children under 14 diagnosed with ISIs between 2015 and 2024.
  • Data on clinical presentation, microbiology, treatments, and outcomes were collected from medical records across six Spanish tertiary hospitals.
  • Descriptive and comparative analyses, including logistic regression, were used to identify factors influencing outcomes.

Main Results:

  • Brain abscess (44%) was the most common diagnosis, often originating from otorhinolaryngologic sources in older children.
  • Streptococcus species were the most frequent isolates (42.7%), with significant variation in empirical antibiotic regimens.
  • Switching to oral antibiotics was successful in 28.8% of patients without increasing complications; sequelae occurred in 29.3%, particularly in infants.

Conclusions:

  • Pediatric intracranial suppurative infections lead to significant morbidity and show management variability across institutions.
  • A subset of patients can transition to oral antibiotics after initial IV therapy, warranting further investigation.
  • Standardized treatment protocols are crucial for improving outcomes and minimizing neurological sequelae in pediatric patients.
Abstract

Keywords:
brain abscessepidural empyemaintracranial suppurative infectionsoral switchsubdural empyema

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