Intravenous Antibiotic Treatment With Oral Relay in Pediatric Intracranial Abscesses: A 20-Year Descriptive Monocentric Cohort in France.

BACKGROUND

Brain abscesses/empyema are suppurated intra- or peri-cerebral accumulations. The incidence is low, and mortality is decreasing, but their management remains nonconsensual. Our aim was to describe the duration of antibiotic therapy required to cure our infected population and to identify factors associated with prolonged intravenous antibiotic therapy lasting more than 3 weeks, according to our local protocol.

METHODS

Pediatric patients with cerebral abscess/empyema treated at Toulouse University Hospital between January 2002 and October 2022 were included. Clinical, biologic, radiologic and therapeutic characteristics, as well as the presence of sequelae, were recorded. A univariate analysis was performed to compare the "≤3 weeks intravenous" group with the ">3 weeks intravenous" group.

RESULTS

Seventy patients were included. One patient died quickly of cerebellar involvement. There were no recurrences. The median total duration of antibiotic treatment was 42 days (42; 59), and 22.5 days for intravenous antibiotic therapy alone (21; 36). Factors associated with a longer period than 3 weeks of intravenous antibiotic treatment were: the presence of an abscess, epileptic seizure/neurologic deficit at diagnosis and a neurosurgical procedure. Significant cognitive sequelae were also associated with an extended period of treatment. Persistent contrast enhancement at the time of switching and of discontinuing antibiotic therapy was not associated with an extended period of antibiotic therapy.

CONCLUSIONS

This study suggested that a 3-week course of intravenous antibiotic therapy combined with a 3-week course of oral antibiotics is sufficient for full recovery in many children with brain abscesses or empyema. Complicated cases require a more extended period of antibiotic therapy.