Duration of therapy for S. aureus bacteraemia in children

Campbell, Al Yazidi, 2022Campbell, Dotel, 2022McMullan, 2016McMullan, 2020

There are few data to guide the duration of therapy for S. aureus bacteraemia in children. The duration of therapy recommended in these guidelines is based on extensive clinical experience, and is consistent with the Australian and New Zealand Paediatric Infectious Diseases Australasian Stewardship of Antimicrobials in Paediatrics group consensus recommendations. Seek expert advice on the duration of intravenous and total therapy for each child and neonate with S. aureus bacteraemia.

Duration of therapy depends on whether the bacteraemia is caused by methicillin-susceptible S. aureus (MSSA) or methicillin-resistant S. aureus (MRSA), and whether the child has complicated infection. Children have complicated S. aureus bacteraemia if they meet any of the following criteria:

  • persistent bacteraemia
  • delayed response to therapy
  • metastatic infection (eg osteomyelitis, septic arthritis, pneumonia, lung abscess, endocarditis).

The duration of therapy for complicated infection is generally longer than that for uncomplicated infection – seek expert advice.

The duration of therapy for S. aureus bacteraemia in children without complications is usually:McMullan, 2020

  • MSSA bacteraemia
    • in neonates, 14 days of intravenous therapy after the first negative blood culture result
    • in children 1 month or older, 7 days of intravenous therapy after the first negative blood culture result
  • MRSA bacteraemia – a minimum of 14 days of intravenous therapy after the first negative blood culture result.

The treatment course for children with S. aureus bacteraemia must be completed with intravenous therapy. The exception is bacteraemia of bone or joint source, when the duration of intravenous therapy may be shortened to 4 days if all of the following criteria apply:

  • bones or joints are the only focus of bacteraemia
  • bacteraemia resolved rapidly (blood culture results were negative at 48 to 72 hours)
  • the child is clinically improving
  • a suitable oral antibiotic formulation is available for continuation therapy.

For duration of intravenous and total therapy for bone and joint infections, seek expert advice; see also Duration of therapy for osteomyelitis in children and Intravenous to oral switch and duration of therapy for native joint septic arthritis.