Short-course antibiotic treatment of bone and joint infections in children: a retrospective study at Montpellier University Hospital from 2009 to 2013

Abstract

Background Acute haematogenous bone and joint infections (AHBJI) represent a diagnostic and therapeutic emergency in children, with significant potential sequelae in the case of delayed treatment. Although historically the recommendations for treatment have been based on surgery and prolonged antibiotic therapy, recent studies have demonstrated that short-course antibiotic therapy is also effective. Objectives We evaluated a short-term antibiotic protocol for both osteomyelitis and septic arthritis in a 6 year retrospective study at the University Hospital of Montpellier. Methods This protocol was based on an initial intravenous treatment with a re-evaluation after 48 h and an early switch to oral therapy in the case of a favourable clinical course for a minimum total duration of 15 days. Antibiotics were selected based on local microbiological epidemiology and systematically adapted to bacteriological results. Results One hundred and seventy-six cases of AHBJI were included, comprising 56 patients with osteomyelitis, 95 with septic arthritis and 25 who had both of these. The aetiological agent was identified in 42% of the cases, with the main pathogens being Staphylococcus aureus (39%) and Kingella kingae (27%). The mean intravenous treatment duration was 4 days, while the total treatment duration was 15 days. There were no treatment failures, mild sequelae occurred in 1% of the cases and the secondary surgical revision rate was 7%. Conclusions The results of this study are comparable to those reported for evaluations of prolonged antibiotic therapy protocols, thus indicating that a common short-term antimicrobial therapy for the management of both osteomyelitis and septic arthritis (minimum of 15 days) is a viable option for treating AHBJI in children. Further prospective studies to confirm these findings are hence warranted.

Amoxicillin-Clavulanic Acid Empirical Oral Therapy for the Management of Children with Acute Haematogenous Osteomyelitis

“…In Filleron et al study, 176 children were included in the retrospective study: 56 with OM, 95 with SA and 25 with both OM and SA. Oral therapy with amoxicillin-clavulanic acid was administered in 82/176 children (46.6%) [14]. Sequelae were observed in two children (1%) [14] (Table 3).…”

“…Oral therapy with amoxicillin-clavulanic acid was administered in 82/176 children (46.6%) [14]. Sequelae were observed in two children (1%) [14] (Table 3). Roul-Levy et al retrospectively compared two groups of children treated for AHOM (n = 45) [19].…”

“…Historically, AHOM was treated with intravenous (IV) antibiotics for several weeks [1]. However, accumulating data support the use of short IV therapy followed by oral antibiotic therapy in uncomplicated cases [11][12][13][14][15] since this regimen appears to be as effective as longer antibiotic IV courses with no increased risk of complications or sequelae. Short IV therapy (about seven days) is now adopted by several centers in Europe [14] and the US [15].…”

“…However, accumulating data support the use of short IV therapy followed by oral antibiotic therapy in uncomplicated cases [11][12][13][14][15] since this regimen appears to be as effective as longer antibiotic IV courses with no increased risk of complications or sequelae. Short IV therapy (about seven days) is now adopted by several centers in Europe [14] and the US [15]. The European Society of Paediatric Infectious Diseases (ESPID) guidelines for Bone and Joint infections [1] recommend switching from cefazolin to cephalexin or cefuroxime, IV clindamycin to oral clindamycin, and IV ceftriaxone + oxacillin to oral equivalents, such as dicloxacillin or flucloxacillin.…”

“…At the same time, amoxicillin-clavulanic acid is considered an alternative option. However, "thorough evidence is lacking, and the tolerance is worse" [1,[13][14][15]. However, several practical issues may arise.…”