Parenteral and oral antibiotic duration for treatment of pediatric osteomyelitis: a systematic review protocol

Grimbly, Chelsey; Odenbach, Jeff; Vandermeer, Ben; Forgie, Sarah; Curtis, Sarah

doi:10.1186/2046-4053-2-92

Cited by 18 publications

(11 citation statements)

References 18 publications

(24 reference statements)

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“…Despite the considerable variability in the management of pediatric AHO, a growing body of evidence indicates that a shorter course of intravenous (IV) antibiotic therapy followed by an early transition to oral antibiotic therapy may offer a similar success rate in children with uncomplicated osteomyelitis compared to prolonged IV therapy alone while avoiding the complications related to the use of a venous catheter. [27][28][29][30][31][32][33][34] Studies have documented substantial risks associated with use of prolonged IV therapy for AHO. In a 2006 retrospective cohort study from the United States, of the 75 patients who received prolonged IV therapy (>2 weeks) for AHO, 41% had ࣙ1 central venous catheter (CVC)associated complication.…”

Section: Managementmentioning

confidence: 99%

Acute Hematogenous Osteomyelitis in Children

Thakolkaran¹,

Shetty

2019

TOJ

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Background:The epidemiology of acute hematogenous osteomyelitis (AHO) in children has changed. Methods: We reviewed the current literature regarding the epidemiology, microbiology, pathogenesis, clinical presentation, diagnosis, and antimicrobial management of AHO in children. Results: Staphylococcus aureus is the most common microorganism causing pediatric AHO, followed by group A Streptococcus (GAS). AHO due to community-associated methicillin-resistant Staphylococcus aureus (MRSA) can cause severe and complicated disease. Pathogen isolation by culture is key for targeted antibiotic therapy. Polymerase chain reaction assay in tissue sample or joint fluid may enhance the yield of Kingella kingae. C-reactive protein is useful in diagnosis and monitoring the course of AHO. Magnetic resonance imaging is the preferred diagnostic imaging study for AHO. Clindamycin or vancomycin (for serious disease) is recommended for empiric therapy of suspected AHO due to MRSA depending on the geographic prevalence. Penicillinase-stable penicillins or first-generation cephalosporins are preferred antibiotics to treat methicillin-sensitive S aureus (MSSA) infection. Betalactam agents are the drugs of choice for treating AHO due to K kingae, GAS, or Streptococcus pneumoniae. For uncomplicated AHO due to MSSA, a short parenteral antibiotic course followed by oral therapy for a minimum total duration of 3-4 weeks is adequate. Complicated AHO due to MRSA may warrant prolonged therapy with surgical intervention. Conclusion: Given the evolution of pathogens, the variability in clinical presentations and course ranging from simple to complex disease, and response to treatment, the management of AHO continues to evolve and warrants an individualized, multidisciplinary approach.The nonspecific markers of inflammation-CRP and erythrocyte sedimentation rate (ESR)-are commonly used in the initial evaluation of AHO. 17 CRP has a half-life of 19 hours

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Section: Managementmentioning

confidence: 99%

Acute Hematogenous Osteomyelitis in Children

Thakolkaran¹,

Shetty

2019

TOJ

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“…However, the long duration of parenteral therapy was associated with prolonged hospitalization, high cost, and sometimes the need for central venous access. Some centers start the peripheral intravenous therapy for some days during hospitalization and then insert a central venous catheter to provide four to six weeks of parenteral therapy at home [ 45 ].…”

Section: The Duration Of Anti-infective Treatmentmentioning

confidence: 99%

Update on the Management of Pediatric Acute Osteomyelitis and Septic Arthritis

Castellazzi

Mantero

Esposito

2016

IJMS

139

119

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Acute osteomyelitis and septic arthritis are two infections whose frequencies are increasing in pediatric patients. Acute osteomyelitis and septic arthritis need to be carefully assessed, diagnosed, and treated to avoid devastating sequelae. Traditionally, the treatment of acute osteoarticular infection in pediatrics was based on prolonged intravenous anti-infective therapy. However, results from clinical trials have suggested that in uncomplicated cases, a short course of a few days of parenteral antibiotics followed by oral therapy is safe and effective. The aim of this review is to provide clinicians an update on recent controversies and advances regarding the management of acute osteomyelitis and septic arthritis in children. In recent years, the emergence of bacterial species resistant to commonly used antibiotics that are particularly aggressive highlights the necessity for further research to optimize treatment approaches and to develop new molecules able to fight the war against acute osteoarticular infection in pediatric patients.

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“…With the increase of open fractures and orthopedic procedures, the incidence of osteomyelitis is significantly increasing [ 2 ]. However, due to lack of effective management, osteomyelitis causes serious morbidity and causes a great deal of physical and psychological damage to patients [ 3 ]. Staphylococcus aureus ( S. aureus ) is the most common causative organism in osteomyelitis [ 4 , 5 ], and accounts for approximately 80% of all osteomyelitis cases [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Staphylococcus Aureus Induces Osteoclastogenesis via the NF-κB Signaling Pathway

Ren

Wang

et al. 2017

Med Sci Monit

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BackgroundOsteomyelitis is one of the refractory diseases encountered in orthopedics, while Staphylococcus aureus (S. aureus) is the most common causative organism in osteomyelitis. However, the precise mechanisms underlying the bone loss caused by S. aureus infection have not been well defined. Here, we investigated the effect of S. aureus on osteoclast differentiation and the probable molecular mechanism.Material/MethodsRAW 264.7 cells were treated for 5 days with live S. aureus, inactivated S. aureus, and S. aureus filtrate. Then, the formation of osteoclast-like cells and resorption pits was observed, and the expression of osteoclast-specific genes (TRAP, MMP-9, cathepsin K, CTR and Atp6v0d2) was detected by real-time PCR. Moreover, key proteins in the signaling pathway associated with osteoclast differentiation were detected with Western blot.ResultsThe data showed that live S. aureus, inactivated S. aureus, and S. aureus filtrate induced osteoclast formation, promoted bone resorption, and increased the expression of osteoclast-specific genes in a dose-dependent manner in the absence RANKL. In addition, we found that the S. aureus-induced osteoclastogenesis was related to the degradation of IκB-α, phosphorylation of NF-κB p65, and increased expression of NFATc1. Thus, we used JSH-23 to inhibit NF-κB transcriptional activity. The effect of the S. aureus-induced osteoclastogenesis and the expression of osteoclast-specific genes and NFATc1 were inhibited, which indicated that the NF-κB signaling pathway plays a role in S. aureus-induced osteoclastogenesis.ConclusionsThis study demonstrated that S. aureus induces osteoclastogenesis through its cell wall compound and secretion of small soluble molecules, and the NF-κB signaling pathway plays a role in this process.

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Parenteral and oral antibiotic duration for treatment of pediatric osteomyelitis: a systematic review protocol

Cited by 18 publications

References 18 publications

Acute Hematogenous Osteomyelitis in Children

Acute Hematogenous Osteomyelitis in Children

Update on the Management of Pediatric Acute Osteomyelitis and Septic Arthritis

Staphylococcus Aureus Induces Osteoclastogenesis via the NF-κB Signaling Pathway

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