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Prospective evaluation of a shortened regimen of treatment for acute osteomyelitis and septic arthritis in children
Journal of Pediatric Orthopaedics , 07/06/09

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.

Methods

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

Results

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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