Antibiotic duration and timing of the switch from intravenous to oral route for bacterial infections in children: systematic review and guidelines

Brendan J McMullan; David Andresen; Christopher C Blyth; Minyon L Avent; Asha C Bowen; Philip N Britton; Julia E Clark; Celia M Cooper; Nigel Curtis; Emma Goeman; Briony Hazelton; Gabrielle M Haeusler; Ameneh Khatami; James P Newcombe; Joshua Osowicki; Pamela Palasanthiran; Mike Starr; Tony Lai; Clare Nourse; Joshua R Francis; David Isaacs; Penelope A Bryant; ANZPID-ASAP group

doi:10.1016/S1473-3099(16)30024-X

Antibiotic duration and timing of the switch from intravenous to oral route for bacterial infections in children: systematic review and guidelines

Lancet Infect Dis. 2016 Aug;16(8):e139-52. doi: 10.1016/S1473-3099(16)30024-X. Epub 2016 Jun 16.

Authors

Brendan J McMullan¹, David Andresen², Christopher C Blyth³, Minyon L Avent⁴, Asha C Bowen⁵, Philip N Britton⁶, Julia E Clark⁷, Celia M Cooper⁸, Nigel Curtis⁹, Emma Goeman¹⁰, Briony Hazelton¹¹, Gabrielle M Haeusler¹², Ameneh Khatami¹³, James P Newcombe¹⁰, Joshua Osowicki¹⁴, Pamela Palasanthiran¹, Mike Starr¹⁵, Tony Lai¹⁶, Clare Nourse⁷, Joshua R Francis¹⁷, David Isaacs⁶, Penelope A Bryant¹⁸; ANZPID-ASAP group

Affiliations

¹ Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, NSW, Australia; School of Women's and Children's Health, University of New South Wales, NSW, Australia.
² Department of Infectious Diseases, Immunology, and HIV Medicine, St Vincent's Hospital, Darlinghurst, NSW, Australia; Sydney Medical School, University of Sydney, NSW, Australia.
³ Department of Infectious Diseases, Princess Margaret Hospital for Children, Subiaco, WA, Australia; School of Paediatrics and Child Health, University of Western Australia, WA, Australia; PathWest Laboratory Medicine, WA, Australia; Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, WA, Australia.
⁴ The University of Queensland, UQ Centre for Clinical Research and School of Public Health, Herston, QLD, Australia.
⁵ Department of Infectious Diseases, Princess Margaret Hospital for Children, Subiaco, WA, Australia; School of Paediatrics and Child Health, University of Western Australia, WA, Australia; Menzies School of Health Research, Darwin, NT, Australia; Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, WA, Australia.
⁶ Department of Infectious Diseases & Microbiology, Children's Hospital at Westmead, Westmead, NSW, Australia; Discipline of Paediatrics and Child Health, University of Sydney, Sydney, NSW, Australia.
⁷ Infection Management and Prevention Service, Lady Cilento Children's Hospital, South Brisbane, QLD, Australia; School of Medicine, University of Queensland, Brisbane, QLD, Australia.
⁸ Department of Microbiology and Infectious Diseases, SA Pathology, Women's and Children's Hospital, North Adelaide, SA, Australia.
⁹ Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital Melbourne, Parkville, VIC, Australia; Murdoch Children's Research Institute, Parkville, VIC, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia.
¹⁰ Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, NSW, Australia.
¹¹ Sydney Medical School, University of Sydney, NSW, Australia; Department of Infectious Diseases, Princess Margaret Hospital for Children, Subiaco, WA, Australia.
¹² Department of Infectious Diseases and Infection Control, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Department of Infection and Immunity, Monash Children's Hospital, Clayton, VIC, Australia.
¹³ Department of Infectious Diseases & Microbiology, Children's Hospital at Westmead, Westmead, NSW, Australia.
¹⁴ Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital Melbourne, Parkville, VIC, Australia; Murdoch Children's Research Institute, Parkville, VIC, Australia.
¹⁵ Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital Melbourne, Parkville, VIC, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia.
¹⁶ Department of Pharmacy, Children's Hospital at Westmead, Westmead, NSW, Australia.
¹⁷ Department of Paediatrics, Royal Darwin Hospital, Darwin, NT, Australia.
¹⁸ Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital Melbourne, Parkville, VIC, Australia; Murdoch Children's Research Institute, Parkville, VIC, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia. Electronic address: [email protected].

PMID: 27321363
DOI: 10.1016/S1473-3099(16)30024-X

Abstract

Few studies are available to inform duration of intravenous antibiotics for children and when it is safe and appropriate to switch to oral antibiotics. We have systematically reviewed antibiotic duration and timing of intravenous to oral switch for 36 paediatric infectious diseases and developed evidence-graded recommendations on the basis of the review, guidelines, and expert consensus. We searched databases and obtained information from references identified and relevant guidelines. All eligible studies were assessed for quality. 4090 articles were identified and 170 studies were included. Evidence relating antibiotic duration to outcomes in children for some infections was supported by meta-analyses or randomised controlled trials; in other infections data were from retrospective series only. Criteria for intravenous to oral switch commonly included defervescence and clinical improvement with or without improvement in laboratory markers. Evidence suggests that intravenous to oral switch can occur earlier than previously recommended for some infections. We have synthesised recommendations for antibiotic duration and intravenous to oral switch to support clinical decision making and prospective research.

Publication types

Review
Systematic Review

MeSH terms

Administration, Intravenous*
Administration, Oral*
Anti-Bacterial Agents / therapeutic use*
Bacterial Infections / drug therapy*
Humans
Pediatrics

Substances

Anti-Bacterial Agents