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Acute infectious osteomyelitis in children: new treatment strategies for an old enemy

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Abstract

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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Authors and Affiliations

  1. Department of Women’s and Children’s Health, University of Padua, Padua, Italy

    Sabrina Congedi & Chiara Minotti

  2. Division of Paediatric Infectious Diseases, Department of Women’s and Children’s Health, University of Padua, Padua, Italy

    Carlo Giaquinto & Daniele Donà

  3. Paediatric Emergency Department, Department of Women’s and Children’s Health, University of Padua, Padua, Italy

    Liviana Da Dalt

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  1. Sabrina Congedi
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  2. Chiara Minotti
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  3. Carlo Giaquinto
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  4. Liviana Da Dalt
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  5. Daniele Donà
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Contributions

CS, MC, GC, DDL, and DD have made substantial contributions to the conception, design, collection, and interpretation of data for this review, drafted the manuscript, revised it critically for content, and approved the final version.

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Correspondence to Chiara Minotti.

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Congedi, S., Minotti, C., Giaquinto, C. et al. Acute infectious osteomyelitis in children: new treatment strategies for an old enemy. World J Pediatr 16, 446–455 (2020). https://doi.org/10.1007/s12519-020-00359-z

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