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Concern about serious bacterial infection is a common reason for children to be admitted to hospital, many of whom are given parenteral antibiotics. Once children are converted to oral antibiotics, they are usually discharged home, so the length of parenteral antibiotic treatment is a major determinant of length of stay and total cost of care (unless children can be discharged home on outpatient parenteral antibiotic therapy). The excellent bioavailability of some oral antibiotics (quinolones, clindamycin) means these drugs can rapidly achieve adequate blood levels, making a switch to oral antibiotics more appealing.
The duration and route of antimicrobial treatment required for many childhood infections is often based on expert opinion and rarely on evidence. This is particularly true for the duration of parenteral antibiotics for children with Gram-negative blood stream infections. The Infectious Diseases Society of America guidelines for the treatment of catheter-related bloodstream infections acknowledge the lack of evidence in this area, but suggest 7–14 days of intravenous antibiotics should be given for central venous catheter infections due to Gram-negative bacilli.1 This expert opinion has been taken by some to suggest that up to 14 days of intravenous antibiotics should be given for all blood stream infections due to Gram-negative bacilli in children, such as Escherichia coli. However, no guidance exists for duration of parenteral antibiotic treatment for children who are bacteraemic with a urinary tract infection …