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Antibiotic Treatment Duration for Salmonella Osteoarticular Infections in Children - A Systematic Review and
Mathias Alexander Højagergaard1,2, Sara Thønnings3, Lillian Marie Søes3
1Department of Paediatrics, Copenhagen University Hospital, Hvidovre, Denmark.
Insights
Paediatric Salmonella osteoarticular infections often resolve within current antibiotic guidelines. Individualized treatment durations, guided by patient response, appear effective for pediatric Salmonella bone and joint infections.
Area of Science:
- Pediatric Infectious Diseases
- Orthopedic Surgery
- Pharmacology
Background:
- Current expert opinion guidelines recommend 4-6 weeks of antibiotic therapy for pediatric Salmonella osteoarticular infections.
- The efficacy of these recommended durations requires validation through clinical studies.
Purpose of the Study:
- To validate existing treatment guidelines for pediatric Salmonella osteoarticular infections.
- To investigate the optimal duration of antibiotic treatment for these infections.
Main Methods:
- A systematic literature review was conducted following PRISMA guidelines.
- Searches included PubMed, Medline, Embase, Scopus, and Google Scholar for pediatric cases (1990-2025).
- Included were confirmed Salmonella osteoarticular infections.
Main Results:
- 173 of 214 children had reported outcomes; 117 healthy children recovered with a median 6-week treatment.
- 32 children with comorbidities recovered with a median 8-week treatment.
- No significant association was found between antibiotic duration and treatment outcome.
Conclusions:
- Most children recovered within the recommended 4-6 week antibiotic treatment duration.
- Individualized treatment durations, based on clinical response, are suggested.
- Significant variation in prescribed antibiotic durations was observed.
Aim:
Current guidelines based on expert opinions recommend a minimum of 4-6 weeks of antibiotic treatment for paediatric Salmonella osteoarticular infections. In this study, we aim to validate guidelines and investigate the duration of antibiotic treatment.
Methods:
PubMed, Medline, Embase, Scopus, and Google Scholar were searched for cases according to the PRISMA guidelines. We included all paediatric cases from January 1990 to December 2025 with confirmed Salmonella osteoarticular infection.
Results:
Outcome was reported in 173 (81%) of 214 children; 117 (68%) previously healthy children fully recovered after a median antibiotic treatment duration of 6.0 weeks, and 32 (18%) children with comorbidities including sickle cell disease fully recovered after a median duration of 8.0 weeks. For all children, approximately half of the treatment duration was administered intravenously. Multivariable logistic regression analysis demonstrated no independent association between antibiotic treatment duration and outcome.
Conclusion:
The majority of children fully recovered after an antibiotic treatment duration within the current guidelines of minimum four weeks in case of joint infection only and six weeks in case of bone infection. The variation in antibiotic treatment durations was substantial. Individualized treatment durations within the recommended timeframe seem reasonable based on the clinical and paraclinical response.
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