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Benefits and risks of sequential parenteral--oral cephalosporin therapy for suppurative bone and joint infections
Insights
Sequential cephalosporin antibiotic therapy is effective for suppurative skeletal infections in children. However, oral therapy requires careful monitoring of serum bactericidal activity to ensure patient safety and treatment success.
Area of Science:
- Pediatric Infectious Diseases
- Orthopedic Surgery
- Pharmacology
Background:
- Suppurative skeletal infections pose significant treatment challenges in pediatric patients.
- Sequential parenteral-oral antibiotic regimens are commonly employed.
- Optimizing oral antibiotic efficacy and safety is crucial for successful treatment outcomes.
Purpose of the Study:
- To evaluate the efficacy and safety of a sequential parenteral-oral cephalosporin regimen for suppurative skeletal infections in infants and children.
- To assess the role of oral cephalosporins (cefaclor, cephalexin) in outpatient management.
- To determine the importance of monitoring serum bactericidal activity during oral antibiotic therapy.
Main Methods:
- A cohort of 75 infants and children with suppurative skeletal infections were treated.
- Initial parenteral therapy with cefamandole or cefuroxime for a median of 5 days.
- Subsequent oral therapy with high-dose cefaclor or cephalexin.
- Monitoring of serum bactericidal activity and patient outcomes.
Main Results:
- Most patients responded well to the sequential parenteral-oral cephalosporin regimen.
- Eleven percent of patients on cefaclor exhibited inadequate serum bactericidal activity.
- Alternative oral antibiotics or resumption of parenteral therapy were successful in managing these cases.
- One case of chronic disease occurred due to inadequate oral antibiotic activity.
Conclusions:
- Sequential parenteral-oral cephalosporin therapy can be a successful approach for pediatric skeletal infections.
- Oral antibiotic therapy necessitates rigorous laboratory monitoring for compliance and serum bactericidal activity.
- Treatment failure and potential chronic disease underscore the risks of inadequate monitoring.
Abstract:
Seventy-five infants and children with suppurative skeletal infections were managed with a sequential parenteral-oral regimen of cephalosporin antibiotic therapy. Initially, parenteral antibiotics (cefamandole for 48 patients and cefuroxime for 27 patients) were given for a median of 5 days. Oral therapy was with large doses of cefaclor (150 mg/kg/day) or cephalexin (100 mg/kg/day). Eight patients (11%) had inadequate serum bactericidal activity with cefaclor. Six of them were successfully managed with alternative oral antibiotics, and parenteral therapy resumed in one patient. Chronic disease developed in a child who was continued on oral cloxacillin therapy in spite of absent serum bactericidal activity. It is concluded that oral therapy can be successful for the majority of patients but that it is hazardous and not indicated if careful laboratory monitoring of compliance and serum bactericidal activity cannot be performed.