Affiliation:
1. From the Division of Infectious Diseases, Helsinki University Central Hospital (HUCH), Hospital for Children and Adolescents, and
2. Departments I and II of Obstetrics and Gynecology, University of Helsinki, Helsinki, Finland.
Abstract
Objective. Recommendations on treatment of acute staphylococcal osteomyelitis of children, based mostly on retrospective analyses, comprise surgical drainage, up to 6 weeks of antimicrobials guided by the erythrocyte sedimentation rate, and the possibility of switching to the oral route only if monitoring of serum bactericidal titer is guaranteed. A prospective study was conducted to test whether the treatment could be simplified.
Design. Fifty pediatric cases of acuteStaphylococcus aureus osteomyelitis were randomized to receive 150 mg/kg/day of cephradine divided in four doses, or 40 mg/kg/day in four doses of clindamycin. The treatment was initiated intravenously, but switched to oral administration mostly within 4 days, using the same doses. The peak antimicrobial serum inhibitory titer or bactericidal titer was not measured. The course of illness was monitored by blood leukocytes, erythrocyte sedimentation rate, and serum C-reactive protein. The follow-up was extended to 1 year posthospitalization.
Setting. Eight tertiary pediatric-orthopedic hospitals in Finland.
Main Outcome Measure. Full recovery and remaining healthy at least 12 months from hospital discharge.
Results. The lower and upper extremities were affected in 72% and 8% of patients, respectively. No surgery at all or needle aspiration only was performed in 62% and drilling in 38%. C-reactive protein and the sedimentation rate normalized within 9 days and 29 days, respectively. X-ray changes developed in 68% but had no prognostic significance. The mean hospitalization time was 11 days, and the total duration of antimicrobials was 23 days. No failure has occurred nor have long-term sequelae been observed in any patient.
Conclusions. Treatment of pediatric acute staphylococcal osteomyelitis can be simplified and costs reduced by keeping surgery at a minimum, shortening hospitalization and the course of antimicrobials, switching quickly to the oral route, and not monitoring serum bactericidal activity.
Publisher
American Academy of Pediatrics (AAP)
Subject
Pediatrics, Perinatology, and Child Health
Reference33 articles.
1. Acute osteomyelitis in children.;Mollan;J Bone Joint Surg [Br.],1977
2. Acute haematogenous osteitis.;Anderson;Arch Dis Child.,1980
3. Acute haematogenous osteomyelitis.;O'Brien;J Bone Joint Surg [Br.],1982
4. Acute hematogenous osteomyelitis in children.;Vaughan;J Pediatr Orthop.,1987
5. Osteomyelitis in infants and children: a review of 163 cases.;Dich;Am J Dis Child.,1975
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