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Oral Ambulatory Treatment of Acute Osteomyelitis in Children: A Case-Control Study
Antoine Roul-Levy1, Vincent Looten, Manon Bachy
1From the *Department of Pediatric Orthopaedics, Armand Trousseau Hospital, Université Pierre et Marie Curie-Paris 6; †Biostatistics and Public Health Department, Pitié-Salpétrière Hospital; and ‡The MAMUTH Hospital-University Department for Innovative Therapies in Musculoskeletal Diseases - Armand Trousseau Hospital, Paris, France.
Insights
Exclusive ambulatory oral treatment for pediatric acute hematogenous osteomyelitis is as effective as traditional parenteral-then-oral approaches. This approach offers a shorter treatment duration, demonstrating its validity in non-severe cases.
Area of Science:
- Pediatric Infectious Diseases
- Orthopedic Surgery
- Pharmacology
Background:
- Acute hematogenous osteomyelitis treatment traditionally involves prolonged parenteral antibiotics.
- Current guidelines suggest a 2-4 day parenteral course before switching to oral antibiotics.
- Recent shifts favor shorter parenteral durations and earlier oral transitions.
Purpose of the Study:
- To compare the efficacy and outcomes of exclusive ambulatory oral treatment versus traditional parenteral-then-oral treatment for pediatric acute hematogenous osteomyelitis.
- To evaluate clinical, radiographic, and biologic healing at 6 months post-treatment.
- To assess secondary outcomes including hospitalization length and total treatment duration.
Main Methods:
- Retrospective analysis of 45 children (aged 1-11 years) with non-severe acute osteomyelitis.
- Group 1: 19 patients received exclusive ambulatory oral amoxicillin-clavulanic acid.
- Group 2: 26 patients received 2-4 days of parenteral treatment followed by oral antibiotics.
Main Results:
- No significant difference in primary endpoint (clinical, radiographic, biologic healing at 6 months) between the two groups (P = 0.38).
- Significant difference in total treatment duration, favoring the exclusive oral treatment group (P = 0.049).
- Amoxicillin-clavulanic acid was the primary antibiotic used in both treatment arms.
Conclusions:
- Exclusive ambulatory oral treatment with amoxicillin-clavulanic acid is a viable alternative for children with non-severe acute hematogenous osteomyelitis.
- This approach achieves comparable healing outcomes to the conventional parenteral-then-oral sequence.
- Ambulatory oral treatment may lead to a shorter overall treatment duration.
Abstract:
The treatment of acute hematogenous osteomyelitis has evolved in recent years to a shorter parenteral treatment with an early switch to the oral route. Current publications recommend a 2- to 4-day parenteral treatment before the oral switch. We retrospectively analyzed a series of 45 children aged 1 to 11 years and treated in our department for acute osteomyelitis without severity criterion. Nineteen of 45 patients were treated by an exclusive ambulatory oral treatment by amoxicillin and clavulanic acid. Twenty six of 45 patients had a 2- to 4-day parenteral treatment before the oral switch. The minimum follow-up was 6 months. The primary endpoint was a clinical, radiographic, and biologic healing, 6 months after the beginning of the treatment. The secondary endpoints evaluated were the length of hospitalization, the total duration of treatment, and the type of antibiotic used. On the primary endpoint, we did not find any significant difference between the 2 treatments (P = 0.38). On the duration of treatment, we found a significant difference (P = 0.049) in favor of oral treatment. The ambulatory oral treatment by amoxicillin and clavulanic acid seems to be a valid alternative to the classical parenteral then oral sequence in the treatment of acute hematogenous osteomyelitis in children without severity criterion.
