Duration of antibiotics in children with osteomyelitis and septic arthritis

Abstract

Contrary to expectations and local protocols, most patients were treated with conventional long-duration therapy. Patients treated for short courses had good outcomes. The low rate of complications may make randomized controlled equivalence trials unfeasible. Increasing evidence of the efficacy and safety of short-duration treatment (3-3.5 weeks) for acute, uncomplicated OM or SA in children suggests that this could be accepted as the standard treatment. However, this should be evaluated prospectively using a register, with at least 12 months' of follow-up.

Antibiotic treatment for acute haematogenous osteomyelitis of childhood: Moving towards shorter courses and oral administration

“…Since no prospective, sufficiently powered, randomised trials were available, treatment was based on animal studies [68], expert opinions and the rationale that bone revascularisation after debridement lasts 4 weeks [65]. For years, treatment of AHOM stagnated under the belief that medication should last for 4-6 weeks [2,3,[62][63][64][65][66][67], including an i.v.…”

Route and Length of Therapy of Acute Uncomplicated Hematogenous Osteomyelitis: Do We Have the Answers Yet?

“…1,[3][4][5][6]8 A detailed description of the search is shown in Fig 1. The studies included in this review are listed in Table 1 and the details of the treatment, bacteriology, antibiotics used, and outcomes are shown in Table 2.…”

“…Three were prospective, 3,5,8 2 were retrospective chart reviews, 4,6 and 1 was a retrospective database study. 1 The studies also varied greatly in regard to sample size.…”

“…8 The remaining 4 studies reported an average length of IV therapy of <7 days. [3][4][5][6] Peltola et al and Jagodzinski et al used a priori criteria to guide transition time from IV to oral therapy.…”

“…It is not unusual for practitioners to recommend a long IV course of therapy, even in the face of an uncomplicated case of AHOM. Uncomplicated AHOM has been variably defi ned, but in general it would refer to osteomyelitis in a patient with <14 days of symptoms, no underlying medical conditions, and infection not associated with trauma and not requiring extensive surgical intervention [3][4][5][6] . This review synthesizes the available literature and addresses 2 clinical questions: (1) Is it reasonable to use short-course IV therapy in uncomplicated AHOM in pediatric patients?…”