Safe early switch to oral antibiotics in immunocompetent adults with intracranial bacterial suppurations: Retrospective of a 25-year experience in a tertiary care centre - 29/04/25
, Anne-Marie Korinek a, Rémy Bernard a, Lamine Abdennour a, Bertrand Mathon b, f, Camille Bombled a, Alice Jacquens a, e, Alexandre Bleibtreu c, d, Vincent Degos a, eHighlight |
• | In surgically treated intracranial bacterial suppurations and in properly monitored patients, switching from intravenous to oral antibiotic therapy could be an alternative to prolonged intravenous administration. |
• | The less severe patients were more likely to be switched to oral route earlier. |
• | The switch to oral treatment was not associated with a worse neurological outcome, even when performed before the 14th day of antibiotic therapy. |
Abstract |
Background |
Switching antibiotic therapy from intravenous to oral route (IVOS) has become the standard of care for many deep-seated infections. IVOS seems applicable to intracranial bacterial suppurations (ICBS) with a good safety profile but remains debated and has shown insufficient evidence to be recommended in the latest guidelines. We hypothesize that early IVOS is not associated with a poorer neurological prognosis.
Material |
We conducted a single-center retrospective cohort study in a French tertiary hospital between October 1998 and June 2022. We included adult patients neuro-surgically treated for ICBS, who survived early hospitalization. The primary endpoint was to determine if outcome was associated with the duration of intravenous antibiotic therapy prior to IVOS. Secondary endpoints were total duration of antibiotic treatment, adverse effects and safety parameters.
Results |
We analysed data for 190 patients of whom 91 % underwent IVOS, after a median 9 days (IQR 5–15) of intravenous route. Patients with a favourable 6-month outcome (Glasgow Outcome Scale Extended ≥ 7) were more likely to receive shorter intravenous treatment (8 (IQR 5–15) versus 13 (IQR 5–23) days, p = 0.035). Patients having undergone early IVOS had fewer surgical revisions (p = 0.002). Treatment side effects did not differ between groups.
Conclusion |
In patients with intracranial bacterial suppurations who have undergone surgery and are adequately monitored, switching from intravenous to oral antibiotics was not associated with a worse outcome, even when performed early. The absence of association between IVOS and death or poorer outcome requires confirmation in further studies.
Le texte complet de cet article est disponible en PDF.Keywords : Intracranial suppuration, Brain infection, Antibiotic, Brain abscess, Oral
Abbreviations : CI, EEG, GCS, GOSE, HIV, ICBS, IV, MRI, IVOS
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Vol 55 - N° 3
Article 105043- mai 2025 Retour au numéro
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