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Acute infectious osteomyelitis in children: new treatment strategies for an old enemy
Sabrina Congedi1, Chiara Minotti2, Carlo Giaquinto3
1Department of Women's and Children's Health, University of Padua, Padua, Italy.
Insights
This review highlights the importance of prompt diagnosis and tailored antibiotic treatment for pediatric osteomyelitis. Early assessment of clinical features and local pathogens guides effective management, aiming to prevent long-term complications in children.
Area of Science:
- Pediatric Infectious Diseases
- Musculoskeletal Infections
- Antimicrobial Stewardship
Background:
- Acute osteomyelitis presents a growing challenge in pediatric populations.
- Timely diagnosis and appropriate empirical antibiotic therapy are crucial to prevent sequelae.
- Initial management requires empirical antibiotics targeting common pathogens for specific age groups.
Purpose of the Study:
- To review the current clinical diagnosis and management of childhood osteomyelitis.
- To provide an update on recent recommendations for antibiotic therapy.
- To serve as a guide for understanding the rationale behind osteomyelitis treatment in children.
Main Methods:
- Literature search conducted on PubMed and Cochrane databases (2000-2019).
- Searched in English, French, and Spanish languages.
- Utilized keywords: "osteomyelitis, children, clinical, diagnosis, and treatment".
Main Results:
- Diagnosis and antibiotic choice depend on clinical features, age, and geographic microbiological profiles.
- Intravenous antibiotics followed by oral therapy are recommended, timed by clinical and inflammatory marker improvement.
- Management strategies for challenging pathogens like MRSA and PVL-positive S. aureus are discussed.
Conclusions:
- Presents an updated approach to diagnosing and managing pediatric osteomyelitis.
- Emphasizes the rationale for antibiotic therapy selection and duration.
- Aims to equip clinicians with current recommendations for effective treatment.
Background:
Acute osteomyelitis still represents a significant clinical challenge, with an increasing incidence in paediatric population. A careful assessment and a rapid diagnosis with proper timing and choice of empirical antimicrobial therapy are necessary to avoid sequelae. The initial treatment should consist of empirical antibiotic therapy, to cover the major responsible pathogens in each age group.
Data Sources:
We made a literature search with PubMed and Cochrane database from 2000 to 2019 in English, French, and Spanish languages using the key words "osteomyelitis, children, clinical, diagnosis, and treatment".
Results:
The child's clinical features, age, and the microbiological profile of the geographic area should be evaluated for diagnosis and in the choice of antibiotic treatment. Latest data suggest the administration of intravenous antibiotics for a short period, with subsequent oral therapy, according to the improvement of clinical status and inflammatory markers. For children older than 3 months, the shift to oral medications is already possible after a short course of intravenous therapy, until recovery. The timing for the shift from cefazolin to cephalexin or cefuroxime, intravenous clindamycin to oral clindamycin, and intravenous ceftriaxone + oxacillin to oral equivalents will be decided according to the improvement of clinical status and inflammatory markers. We also present the approach to osteomyelitis due to difficult pathogens, such as Methicillin-resistant Staphylococcus aureus (MRSA) and Panton-Valentine leukocidin (PVL)-positive S. aureus infections.
Conclusion:
In this review, we present the current approach to the clinical diagnosis and management of osteomyelitis in childhood, with an update on recent recommendations, as a useful instrument to understand the rationale of antibiotic therapy.
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