Success in changing from intravenous to oral antibiotics in pediatric intracranial infections: report of three cases

Rita Sousa, Unidade de Infeciologia e Imunodeficiências, Departamento de Pediatria, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal; Serviço de Pediatria, Hospital Garcia de Orta, Almada, Portugal
Marta Andrade, Unidade de Infeciologia e Imunodeficiências, Departamento de Pediatria, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
Joana Jonet, Unidade de Infeciologia e Imunodeficiências, Departamento de Pediatria, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal; Departamento de Pediatria, Hospital de Cascais Dr. José de Almeida, Cascais, Portugal
Samuel Lemos, Departamento de Neurocirurgia, Hospital de Santa Maria, Lisboa, Portugal
Filipa Prata, Unidade de Infeciologia e Imunodeficiências, Departamento de Pediatria, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal;; Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
Vítor Oliveira, Departamento de Otorrinolaringologia, Hospital de Santa Maria, Lisboa, Portugal
Maria Manuel Santos, Departamento de Neurocirurgia, Hospital de Santa Maria, Lisboa, Portugal
José Gonçalo Marques, Unidade de Infeciologia e Imunodeficiências, Departamento de Pediatria, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal; Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal

Introduction: Acute bacterial rhinosinusitis is a common infection in children. Intracranial complications like subdural empyema or brain abscess are rare, albeit with significant morbidity and neurological sequelae. Case report: We present three clinical cases of intracranial suppurative complications secondary to sinus infection in which the transition to oral antibiotic therapy took place between day 14 and day 21 of intravenous treatment. In all, both neurosurgery and otorhinolaryngology surgery with empyema and sinus drainage were performed, the bacterial etiology was identified and clinical cure was achieved with no relapses. Discussion: Although the early transition to oral antimicrobials has been adopted in some countries, effectiveness and safety remain uncertain. The optimal timing for the transition to oral antibiotic therapy is not well established, but an early switch to oral treatment has been suggested to be equally effective and safe.

Keywords: Intracranial infections. Oral therapy. Levofloxacin. Chloramphenicol. Linezolid.