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Wednesday 22 June 2016
Sequential Parenteral to Oral Clindamycin Dosing in Pediatric Musculoskeletal Infection:A Retrospective Review of 30mg/kg/day vs 40mg/kg/day

This week WAidid suggets the reading of a study that investigates the clinical practice of using 30 mg/kg/day of clindamycin as an alternative for outpatient dosing. The review was published on June 2016, 10th on Pediatric Infectious Disease Journal.

An increasing body of evidence suggests that oral antibiotic therapy following parenteral antibiotic use is effective in the treatment of pediatric musculoskeletal infection, including osteomyelitis.
Guidelines of the Infectious Diseases Society of America (IDSA) for the management of children and adolescents with methicillin-resistant Staphylococcus aureus (MRSA) infections suggest parenteral and oral dosing from 30 to 40 mg/kg/day. However, there is limited evidence to guide the decision as to which end of the spectrum of dosing is appropriate for continued oral therapy following hospitalization. Clindamycin provides high bone concentrations that exceed the minimum inhibitory concentration of MRSA irrespective of formulation or regimen utilized. The purpose of this study was to assess the relative risk of readmission due to residual or recurrent infection using a dosing strategy of 30 mg/kg/day (10 mg/kg/dose every 8 hours) of clindamycin for outpatient oral therapy following inpatient intravenous dosing of 40 mg/kg/day for children with deep infections in an MRSA prevalent community. Among 215 children studied, the average outpatient duration of treatment was 32.8 days. There was no significant difference in the rate of readmission between dosing cohorts. Oral dosing of 30 mg/kg/day was effective for musculoskeletal infection in children in an MRSA prevalent community. Illness severity appeared to have greater impact on readmission and sequelae than did antibiotic dosing.

Erickson CM, Sue PK, Stewart K, Thomas MI, Lindsay EA, Jo C, Copley LA

To read the article online click HERE