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

Majewski, Jessica; Vecchio, Michael Del; Aronoff, Stephen C.

doi:10.1542/hpeds.2013-0035

Cited by 7 publications

(2 citation statements)

References 12 publications

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“…Some authors have suggested the possibility of reducing the duration of intravenous antibiotic therapy to only a few days and then continuing the therapy orally [ 3 , 33 , 46 , 47 , 48 , 49 , 50 , 51 , 52 ]. In a prospective randomized study performed by Peltola et al , pediatric patients with acute osteomyelitis caused primarily by MSSA strains treated with oral antibiotics (clindamycin or a first-generation cephalosporin) for 20 days attained the same efficacy as patients treated for 30 days after an initial intravenous treatment of two to four days in both groups [ 48 ].…”

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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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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“…There are also studies with less than 6 weeks of total antimicrobial therapy, especially in the pediatric literature for hematogenous osteomyelitis and/or septic arthritis [ 34 , 35 ]. In this particular setting, a 3-week”s course appears to be sufficient [ 36 – 38 ].…”

Section: Discussionmentioning

confidence: 99%

Study protocol: short against long antibiotic therapy for infected orthopedic sites — the randomized-controlled SALATIO trials

Uçkay

Wirth

Zörner

et al. 2023

Trials

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Background Few studies address the appropriate duration of post-surgical antibiotic therapy for orthopedic infections; with or without infected residual implants. We perform two similar randomized-clinical trials (RCT) to reduce the antibiotic use and associated adverse events. Methods Two unblinded RCTs in adult patients (non-inferiority with a margin of 10%, a power of 80%) with the primary outcomes “remission” and “microbiologically-identical recurrences” after a combined surgical and antibiotic therapy. The main secondary outcome is antibiotic-related adverse events. The RCTs allocate the participants between 3 vs. 6 weeks of post-surgical systemic antibiotic therapy for implant-free infections and between 6 vs. 12 weeks for residual implant-related infections. We need a total of 280 episodes (randomization schemes 1:1) with a minimal follow-up of 12 months. We perform two interim analyses starting approximately after 1 and 2 years. The study approximatively lasts 3 years. Discussion Both parallel RCTs will enable to prescribe less antibiotics for future orthopedic infections in adult patients. Trial registration ClinicalTrial.gov NCT05499481. Registered on 12 August 2022. Protocol version: 2 (19 May 2022)

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Bone and Joint Infections in Children: Acute Hematogenous Osteomyelitis

Agarwal

Aggarwal

2015

Indian J Pediatr

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Acute hematogenous osteomyelitis (AHO) is one of the commonest bone infection in childhood. Staphylococcus aureus is the commonest organism causing AHO. With use of advanced diagnostic methods, fastidious Kingella kingae is increasingly becoming an important organism in etiology of osteoarticular infections in children under the age of 3 y. The diagnosis of AHO is primarily clinical. The main clinical symptom and sign in AHO is pain and tenderness over the affected bone especially in the metaphyseal region. However, in a neonate the clinical presentation may be subtle and misleading. Laboratory and radiological investigations supplement the clinical findings. The acute phase reactants such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) are frequently elevated. Ultrasonography and MRI are key imaging modalities for early detection of AHO. Determination of infecting organism in AHO is the key to the correct antibiotic choice, treatment duration and overall management and therefore, organism isolation using blood cultures and site aspiration should be attempted. Several effective antibiotics regimes are available for managing AHO in children. The choice of antibiotic and its duration and mode of delivery requires individualization depending upon severity of infection, causative organism, regional sensitivity patterns, time elapsed between onset of symptoms and child's presentation and the clinical and laboratory response to the treatment. If pus has been evidenced in the soft tissues or bone region, surgical decompression of abscess is mandatory.

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

Cited by 7 publications

References 12 publications

Update on the Management of Pediatric Acute Osteomyelitis and Septic Arthritis

Update on the Management of Pediatric Acute Osteomyelitis and Septic Arthritis

Study protocol: short against long antibiotic therapy for infected orthopedic sites — the randomized-controlled SALATIO trials

Bone and Joint Infections in Children: Acute Hematogenous Osteomyelitis

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