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SIMPLIFIED TREATMENT OF ACUTE OSTEOMYELITIS IN CHILDREN.

There are a number of controversies about the optimal treatment for acute staphylococcal osteomyelitis in children. Current recommendations generally comprise surgical drainage, and up to six weeks of intravenous antimicrobial therapy guided by the erythrocyte sedimentation rate; patients may be switched to the oral route if monitoring of bactericidal titer is guaranteed. These Finnish investigators prospectively evaluated a radically simplified strategy.

Fifty children, aged 5 months to 15 years, received a first-generation cephalosporin (150 mg/kg a day) or clindamycin (40 mg/kg a day) intravenously for three or four days, followed by oral administration for three or four weeks (bacterial titers were not monitored). Surgery -- usually needle aspiration or drilling -- was restricted largely to obtaining cultures in children admitted to surgical wards.

Ten children had no surgical drainage, 21 had needle aspiration only, and 19 underwent drilling. Serum C-reactive protein normalized to under 20 mg/l within nine days and mean hospitalization time was 11 days. At a mean follow-up of 27 months, all children had recovered (aside from some minor radiologic changes) with no growth disturbances, other sequelae, or relapse.

Comment: While staphylococcal osteomyelitis should never be trivialized, this somewhat radical approach shows that treatment can safely be simplified.

— RA Dershewitz

Published in Journal Watch General Medicine June 17, 1997

Citation(s):

Peltola H et al. Simplified treatment of acute staphylococcal osteomyelitis of childhood. Pediatrics 1997 Jun 99 846-850.

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