Oral antibiotics safe, feasible for select children with osteoarticular infection

In some patients with osteoarticular infections (OAIs), an exclusively oral administration of antibiotics is safe and feasible, suggests a study.

Oral antibiotic administration may be given to patients if they meet the following low-risk criteria: good general condition, no underlying disease, 6 months to 3 years old, appropriate oral tolerance, C-reactive protein (CRP) <80 mg/L, erythrocyte sedimentation rate/CRP ratio ≥0.67, no skin injury, no recent surgery, no cervical spondylodiscitis, and no local complications at onset.

This study utilized the Spanish Network of Osteoarticular Infections, a nationwide multicentre registry comprising 37 hospitals in Spain. The registry prospectively includes clinical characteristics and outcome of children with OAI. One of the hospitals from RioPed provides oral treatment to children who meet certain criteria.

The researchers classified patients into two groups: management with initial intravenous antibiotic therapy (group 1) and exclusive oral administration of antibiotics (group 2). Subsequently, they performed comparisons between the two treatment groups.

Overall, 893 children who initially received intravenous antibiotics were compared with 64 children who received exclusive oral therapy.

Patients from group 2 were younger (33.9 vs 20.3 months; p=0.001), had a lower percentage of Staphylococcus aureus (23.3 percent vs 3.1 percent; p<0.001), a higher proportion of Kingella kingae (12.1 percent vs 28.1 percent; p=0.001), higher erythrocyte sedimentation rate/CRP ratio (1.4 vs 3.3; p<0.001), and lower rate of fever (63 percent vs 48.8 percent; p=0.024) than those in group 1.

Most notably, no complications were reported in group 2.

“OAIs are typically treated initially with intravenous antibiotics,” the researchers said.