Cefuroxime vs a dicloxacillin/chloramphenicol combination for the treatment of parapneumonic pleural effusion and empyema in children

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

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.

Adverse reactions to oxacillin in hospitalized children: a prospective study

OBJECTIVES: follow-up of children exposed to oxacillin during hospitalization focusing on adverse reactions. METHODS: patients were selected from the pediatric wards of two hospitals in Fortaleza (Hospital Universitário Walter Cantídio-HUWC and Hospital Infantil Albert Sabin-HIAS) from the first oxacillin prescription with a prospective cohort study between October, 2000 and July, 2001 (HUWC) and July/2001 and March, 2002 (HIAS). Patients' follow-up was performed by daily visits to the wards and medical charts and prescription analysis. Suspected oxacillininduced adverse reactions (OxAR cases) were notified and classified according to causality and severity. Related statistic tests were completed. RESULTS: of the 130 patients exposed to oxacillin, 27 had OxAR (20.8%). Fever was the most frequent reaction (50%) followed by rash (35.7%). The majority of reactions were considered Probable, for oxacillin was the only medication involved and 92.6% of the cases had Moderate severity with the need of therapeutic interventions caused by OxAR. A significant relation between oxacillin exposure time and OxAR was determined as well as hospitalization time and the appearance of adverse reactions. Exposure time over 14 days to oxacillin was established as a risk factor for OxAR (relative risk = 5.49). CONCLUSIONS: careful administration of oxacillin in children is recommended with established treatment duration. Empiric and prolonged use must be avoided.

The relationship between inhibition of bacterial adhesion to a solid surface by sub-MICs of antibiotics and subsequent development of a biofilm

Many studies have demonstrated that subminimal inhibitory concentrations (sub-MICs) of antibiotics can inhibit initial microbial adherence to medical device surfaces. It has been suggested that, by inhibiting initial adhesion, biofilm formation might be prevented. However, since initial adherence and subsequent biofilm formation may be two distinct phenomena, conclusions regarding the effects of sub-MIC antibiotics on initial adhesion cannot be extrapolated to biofilm formation. In this study, we evaluated the adherence of several clinical isolates of coagulase-negative staphylococci (CoNS) to acrylic and the effect of sub-MICs of vancomycin, cefazolin, dicloxacillin and combinations of these antibiotics on adherence and biofilm formation. Most of the antibiotics used resulted in effective reduction of bacterial adherence to acrylic, in some cases reaching over 70% inhibition of adherence. When strains with a high biofilm-forming capacity were grown in sub-MICs of those antibiotics, there existed combinations of the drugs that significantly inhibited biofilm formation. However, most of the antibiotic combinations that inhibited adherence did not have a profound effect on biofilm formation. When comparing the results of the effect of sub-MIC amounts of antibiotics in inhibiting adherence with their effect on the inhibition of biofilm formation, significant differences were found, mainly when using combinations of antibiotics. In general, the effect on the inhibition of adherence was greater than the effect on inhibiting biofilm formation. These results demonstrate that assays evaluating the inhibition of initial adherence to medical surfaces cannot fully predict the effect on inhibition of biofilm formation.