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Clindamycin vs. first-generation cephalosporins for acute osteoarticular infections of childhood-a prospective quasi-randomized controlled trial

No sufficiently powered trial has examined two antimicrobials in acute osteoarticular infections of childhood. We conducted a prospective, multicentre, quasi-randomized trial in Finland, comparing clindamycin with first-generation cephalosporins. The age of patients ranged between 3 months and 15 ye... Full description

Journal Title: Clinical Microbiology and Infection 2012-06, Vol.18 (6), p.582-589
Main Author: Peltola, H
Other Authors: Pääkkönen, M , Kallio, P , Kallio, M.J.T
Format: Electronic Article Electronic Article
Language: English
Subjects:
Quelle: Alma/SFX Local Collection
Publisher: Oxford, UK: Elsevier Ltd
ID: ISSN: 1198-743X
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title: Clindamycin vs. first-generation cephalosporins for acute osteoarticular infections of childhood-a prospective quasi-randomized controlled trial
format: Article
creator:
  • Peltola, H
  • Pääkkönen, M
  • Kallio, P
  • Kallio, M.J.T
subjects:
  • Administration, Oral
  • Adolescent
  • Anti-Bacterial Agents - administration & dosage
  • Antibacterial agents
  • Antibiotics. Antiinfectious agents. Antiparasitic agents
  • Bacteremia - drug therapy
  • Bacterial Infections - drug therapy
  • Biological and medical sciences
  • Cephalosporins
  • Cephalosporins - administration & dosage
  • Child
  • Child, Preschool
  • childhood
  • clindamycin
  • Clindamycin - administration & dosage
  • Diseases of the osteoarticular system
  • Female
  • Finland
  • Humans
  • Infant
  • Infectious Diseases
  • Infusions, Intravenous
  • Male
  • Medical sciences
  • Microbiology (medical)
  • Miscellaneous. Osteoarticular involvement in other diseases
  • Osteoarthritis - drug therapy
  • osteoarticular infections
  • Osteomyelitis - drug therapy
  • Pharmacology. Drug treatments
  • Prospective Studies
  • septic/purulent arthritis
  • Staphylococcus aureus - isolation & purification
  • Treatment Outcome
ispartof: Clinical Microbiology and Infection, 2012-06, Vol.18 (6), p.582-589
description: No sufficiently powered trial has examined two antimicrobials in acute osteoarticular infections of childhood. We conducted a prospective, multicentre, quasi-randomized trial in Finland, comparing clindamycin with first-generation cephalosporins. The age of patients ranged between 3 months and 15 years, and all cases were culture-positive. We assigned antibiotic treatment intravenously for the first 2–4 days, and continued oral treatment with clindamycin 40 mg/kg/24 h or first-generation cephalosporin 150 mg/kg/24 h in four doses. Surgery was kept to a minimum. Subsiding symptoms and signs and normalization of C-reactive protein (CRP) level were preconditions for the discontinuation of antimicrobials. The main outcome was full recovery without further antimicrobials because of an osteoarticular indication during 12 months after therapy. The intention-to-treat analysis comprised 252 children, 169 of whom were analysed per-protocol: 82 cases of osteomyelitis, 80 of septic arthritis, and seven of osteomyelitis–arthritis. Staphylococcus aureus strains (all methicillin-sensitive) caused 84% of the cases. Except for one non-serious sequela during convalescence in both groups, and two late infections caused by dissimilar agents in one child, all patients recovered. The entire courses (medians) of clindamycin and cephalosporin lasted for 23 and 24 days, respectively. CRP normalized in both groups in 9 days. The patients were discharged, on average, on day 10. Loose stools were reported less often (1%) in the clindamycin group than in the cephalosporin group (7%), but two clindamycin recipients developed rash. Clindamycin or a first-generation cephalosporin, administered mostly orally, perform equally well in childhood osteoarticular infections, provided that high doses and administration four times daily are used. As most methicillin-resistant staphylococci remain clindamycin-sensitive, clindamycin remains an option instead of costly alternatives.
language: eng
source: Alma/SFX Local Collection
identifier: ISSN: 1198-743X
fulltext: fulltext
issn:
  • 1198-743X
  • 1469-0691
url: Link


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titleClindamycin vs. first-generation cephalosporins for acute osteoarticular infections of childhood-a prospective quasi-randomized controlled trial
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creatorPeltola, H ; Pääkkönen, M ; Kallio, P ; Kallio, M.J.T
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descriptionNo sufficiently powered trial has examined two antimicrobials in acute osteoarticular infections of childhood. We conducted a prospective, multicentre, quasi-randomized trial in Finland, comparing clindamycin with first-generation cephalosporins. The age of patients ranged between 3 months and 15 years, and all cases were culture-positive. We assigned antibiotic treatment intravenously for the first 2–4 days, and continued oral treatment with clindamycin 40 mg/kg/24 h or first-generation cephalosporin 150 mg/kg/24 h in four doses. Surgery was kept to a minimum. Subsiding symptoms and signs and normalization of C-reactive protein (CRP) level were preconditions for the discontinuation of antimicrobials. The main outcome was full recovery without further antimicrobials because of an osteoarticular indication during 12 months after therapy. The intention-to-treat analysis comprised 252 children, 169 of whom were analysed per-protocol: 82 cases of osteomyelitis, 80 of septic arthritis, and seven of osteomyelitis–arthritis. Staphylococcus aureus strains (all methicillin-sensitive) caused 84% of the cases. Except for one non-serious sequela during convalescence in both groups, and two late infections caused by dissimilar agents in one child, all patients recovered. The entire courses (medians) of clindamycin and cephalosporin lasted for 23 and 24 days, respectively. CRP normalized in both groups in 9 days. The patients were discharged, on average, on day 10. Loose stools were reported less often (1%) in the clindamycin group than in the cephalosporin group (7%), but two clindamycin recipients developed rash. Clindamycin or a first-generation cephalosporin, administered mostly orally, perform equally well in childhood osteoarticular infections, provided that high doses and administration four times daily are used. As most methicillin-resistant staphylococci remain clindamycin-sensitive, clindamycin remains an option instead of costly alternatives.
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subjectAdministration, Oral ; Adolescent ; Anti-Bacterial Agents - administration & dosage ; Antibacterial agents ; Antibiotics. Antiinfectious agents. Antiparasitic agents ; Bacteremia - drug therapy ; Bacterial Infections - drug therapy ; Biological and medical sciences ; Cephalosporins ; Cephalosporins - administration & dosage ; Child ; Child, Preschool ; childhood ; clindamycin ; Clindamycin - administration & dosage ; Diseases of the osteoarticular system ; Female ; Finland ; Humans ; Infant ; Infectious Diseases ; Infusions, Intravenous ; Male ; Medical sciences ; Microbiology (medical) ; Miscellaneous. Osteoarticular involvement in other diseases ; Osteoarthritis - drug therapy ; osteoarticular infections ; Osteomyelitis - drug therapy ; Pharmacology. Drug treatments ; Prospective Studies ; septic/purulent arthritis ; Staphylococcus aureus - isolation & purification ; Treatment Outcome
ispartofClinical Microbiology and Infection, 2012-06, Vol.18 (6), p.582-589
rights
02012 European Society of Clinical Infectious Diseases
12011 The Authors. Clinical Microbiology and Infection © 2011 European Society of Clinical Microbiology and Infectious Diseases
22015 INIST-CNRS
32011 The Authors. Clinical Microbiology and Infection © 2011 European Society of Clinical Microbiology and Infectious Diseases.
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0Clindamycin vs. first-generation cephalosporins for acute osteoarticular infections of childhood-a prospective quasi-randomized controlled trial
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descriptionNo sufficiently powered trial has examined two antimicrobials in acute osteoarticular infections of childhood. We conducted a prospective, multicentre, quasi-randomized trial in Finland, comparing clindamycin with first-generation cephalosporins. The age of patients ranged between 3 months and 15 years, and all cases were culture-positive. We assigned antibiotic treatment intravenously for the first 2–4 days, and continued oral treatment with clindamycin 40 mg/kg/24 h or first-generation cephalosporin 150 mg/kg/24 h in four doses. Surgery was kept to a minimum. Subsiding symptoms and signs and normalization of C-reactive protein (CRP) level were preconditions for the discontinuation of antimicrobials. The main outcome was full recovery without further antimicrobials because of an osteoarticular indication during 12 months after therapy. The intention-to-treat analysis comprised 252 children, 169 of whom were analysed per-protocol: 82 cases of osteomyelitis, 80 of septic arthritis, and seven of osteomyelitis–arthritis. Staphylococcus aureus strains (all methicillin-sensitive) caused 84% of the cases. Except for one non-serious sequela during convalescence in both groups, and two late infections caused by dissimilar agents in one child, all patients recovered. The entire courses (medians) of clindamycin and cephalosporin lasted for 23 and 24 days, respectively. CRP normalized in both groups in 9 days. The patients were discharged, on average, on day 10. Loose stools were reported less often (1%) in the clindamycin group than in the cephalosporin group (7%), but two clindamycin recipients developed rash. Clindamycin or a first-generation cephalosporin, administered mostly orally, perform equally well in childhood osteoarticular infections, provided that high doses and administration four times daily are used. As most methicillin-resistant staphylococci remain clindamycin-sensitive, clindamycin remains an option instead of costly alternatives.
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5Bacteremia - drug therapy
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21Infusions, Intravenous
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23Medical sciences
24Microbiology (medical)
25Miscellaneous. Osteoarticular involvement in other diseases
26Osteoarthritis - drug therapy
27osteoarticular infections
28Osteomyelitis - drug therapy
29Pharmacology. Drug treatments
30Prospective Studies
31septic/purulent arthritis
32Staphylococcus aureus - isolation & purification
33Treatment Outcome
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titleClindamycin vs. first-generation cephalosporins for acute osteoarticular infections of childhood-a prospective quasi-randomized controlled trial
authorPeltola, H ; Pääkkönen, M ; Kallio, P ; Kallio, M.J.T
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1Adolescent
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atitleClindamycin vs. first-generation cephalosporins for acute osteoarticular infections of childhood-a prospective quasi-randomized controlled trial
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0Contributors are listed in
1Appendix 1
2.
abstractNo sufficiently powered trial has examined two antimicrobials in acute osteoarticular infections of childhood. We conducted a prospective, multicentre, quasi-randomized trial in Finland, comparing clindamycin with first-generation cephalosporins. The age of patients ranged between 3 months and 15 years, and all cases were culture-positive. We assigned antibiotic treatment intravenously for the first 2–4 days, and continued oral treatment with clindamycin 40 mg/kg/24 h or first-generation cephalosporin 150 mg/kg/24 h in four doses. Surgery was kept to a minimum. Subsiding symptoms and signs and normalization of C-reactive protein (CRP) level were preconditions for the discontinuation of antimicrobials. The main outcome was full recovery without further antimicrobials because of an osteoarticular indication during 12 months after therapy. The intention-to-treat analysis comprised 252 children, 169 of whom were analysed per-protocol: 82 cases of osteomyelitis, 80 of septic arthritis, and seven of osteomyelitis–arthritis. Staphylococcus aureus strains (all methicillin-sensitive) caused 84% of the cases. Except for one non-serious sequela during convalescence in both groups, and two late infections caused by dissimilar agents in one child, all patients recovered. The entire courses (medians) of clindamycin and cephalosporin lasted for 23 and 24 days, respectively. CRP normalized in both groups in 9 days. The patients were discharged, on average, on day 10. Loose stools were reported less often (1%) in the clindamycin group than in the cephalosporin group (7%), but two clindamycin recipients developed rash. Clindamycin or a first-generation cephalosporin, administered mostly orally, perform equally well in childhood osteoarticular infections, provided that high doses and administration four times daily are used. As most methicillin-resistant staphylococci remain clindamycin-sensitive, clindamycin remains an option instead of costly alternatives.
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