{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T12:10:35Z","timestamp":1776082235028,"version":"3.50.1"},"reference-count":11,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2024,11,21]],"date-time":"2024-11-21T00:00:00Z","timestamp":1732147200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/501100000925","name":"NHMRC","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,2,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Cefalexin, a first-generation cephalosporin, is commonly used as oral continuation therapy for paediatric bone and joint infections (BJIs). The standard four times daily cefalexin dose makes treatment adherence challenging. A pharmacokinetic modelling study found that a cefalexin dose of 45\u2005mg\/kg (maximum 1.5\u2005g) three times daily achieves the same pharmacodynamic target.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>To evaluate the efficacy and tolerability of three times daily cefalexin dosing in children with BJIs.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Patients and methods<\/jats:title>\n                  <jats:p>Retrospective audit of children aged 1\u201318\u2005years who received cefalexin at a dose of 40\u201350\u2005mg\/kg (maximum 1.5\u2005g) three times daily as oral continuation therapy for a haematogenous BJI at a quaternary paediatric hospital in Australia over a 4\u2005year period (January 2019 to December 2022).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Of 149 children with BJIs treated with three times daily cefalexin dosing, the majority (147\/149; 99%) achieved cure, with two experiencing recurrence of their infection. Most children tolerated the higher cefalexin dose; 4 children experienced gastrointestinal symptoms and 13 developed neutropenia, which was mild in most cases with no associated complications.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>A reduced frequency dosing regimen using a high cefalexin dose of 45\u2005mg\/kg (maximum 1.5\u2005g) three times daily is effective and well tolerated in most children with BJIs.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jac\/dkae423","type":"journal-article","created":{"date-parts":[[2024,11,21]],"date-time":"2024-11-21T04:34:07Z","timestamp":1732163647000},"page":"409-412","source":"Crossref","is-referenced-by-count":1,"title":["Efficacy and tolerability of high-dose cefalexin 45\u2005mg\/kg\/dose (maximum 1.5\u2005g) three times daily in children with bone and joint infections"],"prefix":"10.1093","volume":"80","author":[{"given":"Samar","family":"Hikmat","sequence":"first","affiliation":[{"name":"Department of General Medicine and Infectious Diseases, The Royal Children\u2019s Hospital Melbourne , Parkville, Victoria ,","place":["Australia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9093-3992","authenticated-orcid":false,"given":"Alison","family":"Boast","sequence":"additional","affiliation":[{"name":"Department of General Medicine and Infectious Diseases, The Royal Children\u2019s Hospital Melbourne , Parkville, Victoria ,","place":["Australia"]},{"name":"Department of Paediatrics, The University of Melbourne , Parkville, Victoria ,","place":["Australia"]},{"name":"Antimicrobials and Infectious Diseases Group, Murdoch Children\u2019s Research Institute , Parkville, Victoria ,","place":["Australia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nigel","family":"Curtis","sequence":"additional","affiliation":[{"name":"Department of General Medicine and Infectious Diseases, The Royal Children\u2019s Hospital Melbourne , Parkville, Victoria ,","place":["Australia"]},{"name":"Department of Paediatrics, The University of Melbourne , Parkville, Victoria ,","place":["Australia"]},{"name":"Antimicrobials and Infectious Diseases Group, Murdoch Children\u2019s Research Institute , Parkville, Victoria ,","place":["Australia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amanda","family":"Gwee","sequence":"additional","affiliation":[{"name":"Department of General Medicine and Infectious Diseases, The Royal Children\u2019s Hospital Melbourne , Parkville, Victoria ,","place":["Australia"]},{"name":"Department of Paediatrics, The University of Melbourne , Parkville, Victoria ,","place":["Australia"]},{"name":"Antimicrobials and Infectious Diseases Group, Murdoch Children\u2019s Research Institute , Parkville, Victoria ,","place":["Australia"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2024,11,21]]},"reference":[{"key":"2025020223513232800_dkae423-B1","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1016\/j.jped.2019.10.005","article-title":"Osteoarticular infections in pediatrics","volume":"96 Suppl 1","author":"Alvares","year":"2020","journal-title":"J Pediatr (Rio J)"},{"key":"2025020223513232800_dkae423-B2","doi-asserted-by":"publisher","first-page":"e139","DOI":"10.1016\/S1473-3099(16)30024-X","article-title":"Antibiotic duration and timing of the switch from intravenous to oral route for bacterial infections in children: systematic review and guidelines","volume":"16","author":"McMullan","year":"2016","journal-title":"Lancet Infect Dis"},{"key":"2025020223513232800_dkae423-B3","doi-asserted-by":"publisher","first-page":"947","DOI":"10.1002\/phar.2160","article-title":"Management of pediatric acute hematogenous osteomyelitis, part I: antimicrobial stewardship approach and review of therapies for methicillin-susceptible Staphylococcus aureus, Streptococcus pyogenes, and Kingella kingae","volume":"38","author":"DeRonde","year":"2018","journal-title":"Pharmacotherapy"},{"key":"2025020223513232800_dkae423-B4","doi-asserted-by":"publisher","first-page":"519","DOI":"10.1097\/INF.0000000000002646","article-title":"Twice-and thrice-daily cephalexin dosing for Staphylococcus aureus infections in children","volume":"39","author":"Gwee","year":"2020","journal-title":"Pediatr Infect Dis J"},{"key":"2025020223513232800_dkae423-B5","doi-asserted-by":"publisher","first-page":"124","DOI":"10.1310\/hpj5202-124","article-title":"Pharmacists and pediatric medication adherence: bridging the gap","volume":"52","author":"El-Rachidi","year":"2017","journal-title":"Hosp Pharm"},{"key":"2025020223513232800_dkae423-B6","doi-asserted-by":"publisher","first-page":"1123","DOI":"10.1097\/INF.0b013e3181f55a89","article-title":"Short-versus long-term antimicrobial treatment for acute hematogenous osteomyelitis of childhood: prospective, randomized trial on 131 culture-positive cases","volume":"29","author":"Peltola","year":"2010","journal-title":"Paediatr Infect Dis J"},{"key":"2025020223513232800_dkae423-B7","doi-asserted-by":"publisher","first-page":"1201","DOI":"10.1086\/597582","article-title":"Prospective, randomized trial of 10 days versus 30 days of antimicrobial treatment, including a short-term course of parenteral therapy, for childhood septic arthritis","volume":"48","author":"Peltola","year":"2009","journal-title":"Clin Infect Dis"},{"key":"2025020223513232800_dkae423-B8","doi-asserted-by":"publisher","first-page":"1340","DOI":"10.1097\/INF.0b013e3182a222a6","article-title":"Pharmacokinetics and pharmacodynamics of oral cephalexin in children with osteoarticular infections","volume":"32","author":"Autmizguine","year":"2013","journal-title":"Pediatr Infect Dis J"},{"key":"2025020223513232800_dkae423-B9","doi-asserted-by":"publisher","first-page":"523","DOI":"10.1097\/INF.0000000000002661","article-title":"Frequency of dosing of cephalexin for oral step-down therapy of pediatric osteoarticular infections caused by methicillin-sensitive Staphylococcus aureus","volume":"39","author":"Ramchandar","year":"2020","journal-title":"Pediatr Infect Dis J"},{"key":"2025020223513232800_dkae423-B10","doi-asserted-by":"publisher","first-page":"431","DOI":"10.5863\/1551-6776-24.5.431","article-title":"Antibiotic-Induced neutropenia during treatment of hematogenous osteoarticular infections in otherwise healthy children","volume":"24","author":"Solis","year":"2019","journal-title":"J Pediatr Pharmacol Ther"},{"key":"2025020223513232800_dkae423-B11","doi-asserted-by":"publisher","first-page":"625","DOI":"10.1016\/S2352-4642(24)00133-0","article-title":"Oral versus intravenous empirical antibiotics in children and adolescents with uncomplicated bone and joint infections: a nationwide, randomised, controlled, non-inferiority trial in Denmark","volume":"8","author":"Nielsen","year":"2024","journal-title":"Lancet Child Adolesc Health"}],"container-title":["Journal of Antimicrobial Chemotherapy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jac\/article-pdf\/80\/2\/409\/60774519\/dkae423.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jac\/article-pdf\/80\/2\/409\/60774519\/dkae423.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,2,2]],"date-time":"2025-02-02T23:51:38Z","timestamp":1738540298000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jac\/article\/80\/2\/409\/7905912"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,21]]},"references-count":11,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2024,11,21]]},"published-print":{"date-parts":[[2025,2,3]]}},"URL":"https:\/\/doi.org\/10.1093\/jac\/dkae423","relation":{},"ISSN":["0305-7453","1460-2091"],"issn-type":[{"value":"0305-7453","type":"print"},{"value":"1460-2091","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,2]]},"published":{"date-parts":[[2024,11,21]]}}}