Simplifying the Treatment of Acute Bacterial Bone and Joint Infections in Children

Markus Pääkkönen; Heikki Peltola

Disclosures

Expert Rev Anti Infect Ther. 2011;9(12):1125-1131. 

In This Article

Abstract and Introduction

Abstract

The treatment of acute hematogenous bone and joint infections of children – osteomyelitis (OM), septic arthritis (SA) and OM–SA combination (OM+SA) – has simplified over the past years. The old approach included months-long antibiotic treatment, started intravenously for at least a week, followed by oral completion of the course. Recent prospective randomized trials show that most cases heal with a total course of 3 weeks (OM, OM+SA) or 2 weeks (SA) of an appropriate antibiotic, provided the clinical response is good and C-reactive protein level has normalized. If the prevalence of methicillin-resistant Staphylococcus aureus and Kingella kingae is low, clindamycin and a first-generation cephalosporin are safe, inexpensive and effective alternatives. They should be administered in large doses and four times a day. Clindamycin, vancomycin and expensive linezolid are options against methicillin-resistant Staphylococcus aureus. Extensive surgery beyond a diagnostic sample by aspiration is rarely needed in uncomplicated cases.

Introduction

Acute hematogenous bone and joint infections are rare but potentially devastating diseases that are more prevalent in children.[1] Depending on the localization, they manifest as osteomyelitis (OM), septic arthritis (SA) or their combination OM+SA. The disease is considered acute if time from the onset of symptoms is less than 2 weeks.[2] Any bone or joint can be affected, but the long bones and joints of the lower limbs are most commonly involved.[3] Boys are more prone than girls, which is explained by physical activity leading to repeating minitraumata; the gender ratio is approximately 1.7:1.[1] The traditional treatment comprises of long courses of antibiotics, started with large doses intravenously for a week or so, followed by completion of the course orally for a month or even longer.[2] Aggressive surgery, and in case of SA in the hip or shoulder, routine arthrotomy have been favoured.[1,2] As alternatives to open arthrotomy in SA, arthroscopy[4] and repeated joint aspirations are recommended.[5–8]

We challenged the traditional treatment of OM and SA in our large prospective and randomized treatment trial.[9–11] The aim was to simplify the entire treatment approach of OM, SA and OM+SA by making things simpler than before. Useful evidence-based information was obtained for future guidelines.

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