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Prospective evaluation of a shortened regimen of treatment for acute osteomyelitis and septic arthritis in children
Journal of Pediatric Orthopaedics , 07/01/09

Jagodzinski NA et al. – Study reports that a shortened course of intravenous and oral antibiotic therapy is effective in the management of acute uncomplicated bone and joint sepsis in children.

• Aim was to investigate if children could be safely treated with 3 days of high-dose iv therapy followed by 3 wks of oral therapy in uncomplicated bone and joint infections
• Inclusion criteria for entry into the database were:
  • Children ≤16 years of age who had no underlying disease or medical therapy predisposing to infection, and
  • Who had symptoms for less than 14 days before presentation
• They were all started on iv antibiotics and a predetermined treatment algorithm was followed
• All pts with septic arthritis also underwent joint washout
• Pts were converted to oral antibiotics once they improved clinically and hematologically
• Regular outpatient f/u continued for 1 yr with blood tests and X-rays

• 70 consecutive, eligible children aged 2 wks-14 yrs
• Staphylococci were the only organisms isolated in cases of osteomyelitis
• Whereas Streptococcal infection was more prevalent in pts with septic arthritis
• 59% of children could be converted to oral therapy after 3 days of iv therapy and 86% after 5 days
• Median duration of inpatient stay was 5 days
• 3 wks of oral therapy was appropriate for those pts who received 5 days or less iv treatment
• Temperature and CRP were the best quantitative means of monitoring response to therapy
• All pts were clinically, hematologically, and radiologically normal before discharge 1 yr post-presentation

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