Transitioning antimicrobials from intravenous to oral in pediatric acute uncomplicated osteomyelitis

Table 1 Published studies evaluating the transition of antibiotics from intravenous to oral for acute uncomplicated osteomyelitis in the pediatric population

Ref.	Study type	Population	Objective	Results	Conclusion
Peltola et al[12]	Prospective	50 children (3 mo to 14 yr)	Determined the full recovery rate and remaining health of patients transitioned to oral antibiotics at 12 mo from hospital discharge	100% had full recovery	Treatment of pediatric osteomyelitis can be simplified and costs reduced by switching to oral early on in the treatment course
Le Saux et al[10]	Systematic review (12 prospective studies)	230 children (3 mo to 16 yr)	Compared the cure rates at 6 mo for IV therapy ≤ 7 d and > 7 d	95.2% - ≤ 7 d (P = 0.224) 98.8% - > 7 d (P = 0.248)	Similar cure rates between groups Increased morbidity and cost associated with long-term IV therapy
Prado et al[17]	Retrospective	70 children (< 15 yr)	Assessed the efficacy of the transition to oral antibiotic after 7 d of IV therapy	No child had a complication from treatment	Seven days of an IV antibiotic for the initial treatment phase of acute osteomyelitis was effective in the majority of children
Zaoutis et al[19]	Retrospective cohort	1969 children (2 mo to 17 yr)	Compared the treatment failure rate between patients discharged with IV and oral antibiotics	5% - IV group 4% - Oral group OR = 0.77, 95%CI: 0.49-1.22	Early transition to oral therapy did not increase the risk of treatment failure
Jagodzinski et al[15]	Prospective cohort	70 children ( ≤ 16 yr)	Determined the parameters for prolonged IV antibiotic therapy of > 6 d	Fever > 38.4 °C for 3 to 5 d Admission CRP > 10 mg/dL	3-5 d of IV antibiotic therapy followed by oral therapy for 3 wk is sufficient for uncomplicated osteoarticular infections
Peltola et al[13]	Prospective randomized	131 children (3 mo to 15 yr)	Compared 20-d vs 30-d treatment with IV therapy for the first 2-4 d	98.5% had full recovery	Most childhood osteomyelitis can be treated for a total antibiotic course of 20 d with only 2-4 d of IV therapy
Dartnell et al[7]	Comprehensive systematic review (132 studies)	> 12000 children (< 18 yr)	Reviewed the different features of osteomyelitis to formulate a recommendation on treatment	Short course of IV therapy is acceptable	Clinical improvements of tenderness, normal temperature, and normalized CRP (< 2 mg/dL) are good indicators for converting IV antibiotics to oral1
Arnold et al[14]	Chart review	194 children (1 mo to 18 yr)	Evaluated if CRP is a good marker to use for transitioning therapy to oral	99.5% success rate	CRP (i.e., < 3 mg/dL) is a useful tool along with other clinical findings to help transition to oral therapy
Liu et al[16]	Retrospective	95 children ( ≤ 17 yr)	Compared recurrence rates of osteomyelitis at discharge with IV or oral therapy	0% - Oral 9% - Intravenous (P = 0.59)	Early transition to oral antibiotics may offer similar recurrence rates of osteomyelitis
Howard-Jones et al[18]	Systematic review (28 observational and 6 randomized)	Approximately 3000 children (< 18 yr)	Compared cure rates between shorter and longer durations of IV therapy	77%-100% - Short duration 80%-100% - Long duration	Early transition to oral therapy after 3-4 d of intravenous therapy is as effective as longer courses1
Keren et al[1]	Retrospective cohort	2060 children (2 mo to 18 yr)	Compared therapy failure between PICC administered antibiotics and oral antibiotics	5% - Oral route 6% - PICC route OR = 1.06, 95%CI: 0.70-1.61	No advantage of antibiotics via PICC line Increased complications with PICC line

¹Does not apply to neonates. CRP: C-reactive protein; IV: Intravenous; PICC: Peripherally inserted central catheter.