Antibiotic treatment for acute haematogenous osteomyelitis of childhood: moving towards shorter courses and oral administration

M. Pääkkönen (1, 2) , H. Peltola (1)

1 Hospital for Children and Adolescents
2 TYKS - Turku University Hospital

Acute haematogenous osteomyelitis (AHOM) of childhood usually affects the long bones of the lower limbs. Although almost any agent may cause AHOM, is the most common bacterium, followed by and, in some countries, spp. and Magnetic resonance imaging (MRI) has improved the diagnostic accuracy of traditional radiography and scintigraphy. Except for the pre-treatment diagnostic sample from bone before the institution of antibiotic therapy, no other surgery is usually required. Traditionally, non-neonatal AHOM has been treated with a 1-3-month course of antibiotics, including an intravenous (i.v.) phase for the first weeks, but recent prospective randomised studies challenge this approach. For most uncomplicated cases, a course of 20 days including an i.v. period of 2-4 days suffices, provided large enough doses of a well absorbed agent (clindamycin or a first-generation cephalosporin, local resistance permitting) are used, administration is four times daily and most symptoms and signs subside within a few days. Serum C-reactive protein (CRP) is a good guide in monitoring the course of illness, and the antimicrobial can usually be discontinued if CRP has decreased to <20mg/L. Newer and costly agents, such as linezolid, should be reserved for cases due to resistant strains. AHOM in neonates and immunocompromised patients probably requires a different approach. Because sequelae may develop slowly, follow-up for at least 1 year post hospitalisation is recommended.

Mots clés: Osteomyelitis; Child; Clindamycin; First-generation cephalosporin

Domaines: Microbiologie et Parasitologie

M. Pääkkönen, H. Peltola. Antibiotic treatment for acute haematogenous osteomyelitis of childhood: moving towards shorter courses and oral administration. International Journal of Antimicrobial Agents, 2011, 38 (4), pp.273. ⟨10.1016/j.ijantimicag.2011.04.007⟩. ⟨hal-00725396⟩