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Duration of intravenous antibiotic therapy for children with acute osteomyelitis or septic arthritis: a feasibility study.

de Graaf, Hans and Sukhtankar, Priya and Arch, Barbara and Ahmad, Nusreen and Lees, Amanda and Bennett, Abigail and Spowart, Catherine and Hickey, Helen and Jeanes, Annmarie and Armon, Kate and Riordan, Andrew and Herberg, Jethro and Hackett, Scott and Gamble, Carrol and Shingadia, Delane and Pallett, Ann and Clarke, Stuart C and Henman, Philip and Emonts, Marieke and Sharland, Mike and Finn, Adam and Pollard, Andrew J and Powell, Colin and Marsh, Peter and Ballinger, Claire and Williamson, Paula R and Clarke, Nicholas Mp and Faust, Saul N (2017) Duration of intravenous antibiotic therapy for children with acute osteomyelitis or septic arthritis: a feasibility study. Health technology assessment (Winchester, England), 21 (48). pp. 1-164. ISSN 2046-4924. This article is available to all HEFT staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their HEFT Athens login IDs

Full text not available from this repository.
Official URL: https://www.journalslibrary.nihr.ac.uk/hta/hta2148...

Abstract

BACKGROUND

There is little current consensus regarding the route or duration of antibiotic treatment for acute osteomyelitis (OM) and septic arthritis (SA) in children.

OBJECTIVE

To assess the overall feasibility and inform the design of a future randomised controlled trial (RCT) to reduce the duration of intravenous (i.v.) antibiotic use in paediatric OM and SA.

DESIGN

(1) A prospective service evaluation (cohort study) to determine the current disease spectrum and UK clinical practice in paediatric OM/SA; (2) a prospective cohort substudy to assess the use of targeted polymerase chain reaction (PCR) in diagnosing paediatric OM/SA; (3) a qualitative study to explore families' views and experiences of OM/SA; and (4) the development of a core outcome set via a systematic review of literature, Delphi clinician survey and stakeholder consensus meeting.

SETTING

Forty-four UK secondary and tertiary UK centres (service evaluation).

PARTICIPANTS

Children with OM/SA.

INTERVENTIONS

PCR diagnostics were compared with culture as standard of care. Semistructured interviews were used in the qualitative study.

RESULTS

Data were obtained on 313 cases of OM/SA, of which 218 (61.2%) were defined as simple disease and 95 (26.7%) were defined as complex disease. The epidemiology of paediatric OM/SA in this study was consistent with existing European data. Children who met oral switch criteria less than 7 days from starting i.v. antibiotics were less likely to experience treatment failure (9.6%) than children who met oral switch criteria after 7 days of i.v. therapy (16.1% when switch was between 1 and 2 weeks; 18.2% when switch was > 2 weeks). In 24 out of 32 simple cases (75%) and 8 out of 12 complex cases (67%) in which the targeted PCR was used, a pathogen was detected. The qualitative study demonstrated the importance to parents and children of consideration of short- and long-term outcomes meaningful to families themselves. The consensus meeting agreed on the following outcomes: rehospitalisation or recurrence of symptoms while on oral antibiotics, recurrence of infection, disability at follow-up, symptom free at 1 year, limb shortening or deformity, chronic OM or arthritis, amputation or fasciotomy, death, need for paediatric intensive care, and line infection. Oral switch criteria were identified, including resolution of fever for ≥ 48 hours, tolerating oral food and medicines, and pain improvement.

LIMITATIONS

Data were collected in a 6-month period, which might not have been representative, and follow-up data for long-term complications are limited.

CONCLUSIONS

A future RCT would need to recruit from all tertiary and most secondary UK hospitals. Clinicians have implemented early oral switch for selected patients with simple disease without formal clinical trial evidence of safety. However, the current criteria by which decisions to make the oral switch are made are not clearly established or evidence based.

FUTURE WORK

A RCT in simple OM and SA comparing shorter- or longer-course i.v. therapy is feasible in children randomised after oral switch criteria are met after 7 days of i.v. therapy, excluding children meeting oral switch criteria in the first week of i.v. therapy. This study design meets clinician preferences and addresses parental concerns not to randomise prior to oral switch criteria being met.

FUNDING

The National Institute for Health Research Health Technology Assessment programme.

Item Type: Article
Additional Information: This article is available to all HEFT staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their HEFT Athens login IDs
Subjects: WE Musculoskeletal. Orthopaedics
WS Paediatrics. Child health
Divisions: Womens and Childrens > Paediatrics
Related URLs:
Depositing User: Mrs Caroline Tranter
Date Deposited: 24 Nov 2017 14:15
Last Modified: 24 Nov 2017 14:15
URI: http://www.repository.heartofengland.nhs.uk/id/eprint/1514

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