Paediatric Infectious Disease Unit, Meyer Children's University Hospital, Department of Health Sciences, University of Florence, 50100 Lorence, Italy.
Pediatric and Infectious Diseases Unit, Academic Department, Bambino Gesù Pediatric Hospital, 00146 Rome, Italy.
Int J Environ Res Public Health. 2019 Sep 23;16(19):3557. doi: 10.3390/ijerph16193557.
: The European Society of Pediatric Infectious Diseases (ESPID) guidelines for acute hematogenous osteomyelitis (AHOM) have been published recently. In uncomplicated cases, an early (2-4 days) switch to oral empirical therapy, preferentially with flucloxacillin, is recommended in low methicillin-resistant settings. We conducted a survey with the aim of evaluating the behaviors of Italian pediatricians at this regard. : An open-ended questionnaire investigating the empiric therapy adopted in uncomplicated AHOM children according to age was sent by email to 31 Italian pediatric clinics taking care of children with infectious diseases, and results were analyzed. : The preferred intravenous (IV) regimen was a penicillin plus an aminoglycoside ( = 10; 32.3%) in children aged <3 months, and a combination of a third-generation cephalosporin plus oxacillin ( = 7; 22.6%), or oxacillin alone ( = 6; 19.4%) in those ≥3 months. In every age class, amoxicillin-clavulanate was the first-choice oral antibiotic. Other antibiotics largely used orally included clindamycin, rifampicin, and trimethoprim/sulfamethoxazole. Flucloxacillin was never prescribed. Only 3 centers switched to oral therapy within 7 days in children ≥3 months of age. The most commonly reported reason influencing the time to switch to oral therapy concerned caregivers' adherence to oral therapy. : Adherence to guidelines was poor, and early transition to oral therapy in the clinical practice was rarely adopted. Given the large use of potentially effective, but poorly studied, oral antibiotics such as amoxicillin/clavulanate, trimethoprim/sulfamethoxazole, and rifampicin, our data may stimulate further studies of this regard.
欧洲儿科传染病学会（ESPID）最近发布了急性血源性骨髓炎（AHOM）的指南。在无并发症的情况下，建议在低耐甲氧西林环境中，早期（2-4 天）转换为经验性口服治疗，首选氟氯西林。我们进行了一项调查，旨在评估意大利儿科医生在这方面的行为。
我们通过电子邮件向 31 家意大利儿科诊所发送了一份开放式问卷，调查了根据年龄采用的无并发症 AHOM 儿童的经验性治疗方法，并对结果进行了分析。
<3 个月大的儿童首选静脉（IV）方案是青霉素加氨基糖苷类（= 10；32.3%），而≥3 个月大的儿童首选第三代头孢菌素加苯唑西林（= 7；22.6%）或苯唑西林（= 6；19.4%）。在每个年龄组中，阿莫西林克拉维酸都是首选的口服抗生素。其他广泛用于口服的抗生素包括克林霉素、利福平、和甲氧苄啶/磺胺甲恶唑。从未开过氟氯西林。只有 3 个中心在≥3 个月大的儿童中在 7 天内转为口服治疗。影响转为口服治疗时间的最常见原因是护理人员对口服治疗的依从性。
指南的遵守情况不佳，临床实践中很少采用早期转为口服治疗。鉴于阿莫西林/克拉维酸、甲氧苄啶/磺胺甲恶唑和利福平等潜在有效但研究不足的口服抗生素的大量使用，我们的数据可能会激发这方面的进一步研究。
