PEDIATRICS Vol. 99 No. 6 June 1997, pp. 846-850 (doi:10.1542/peds.99.6.846)
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PEDIATRICS Vol. 99 No. 6 June 1997, pp. 846-850

Simplified Treatment of Acute Staphylococcal Osteomyelitis of Childhood

Received Sep 16, 1996; accepted Dec 3, 1996.

Heikki Peltola*, Leila Unkila-KallioDagger , Markku J.T. Kallio, and the Finnish Study Group

From the * Division of Infectious Diseases, Helsinki University Central Hospital (HUCH), Hospital for Children and Adolescents, and Dagger  Departments I and II of Obstetrics and Gynecology, University of Helsinki, Helsinki, Finland.

Objective.  Recommendations on treatment of acute staphylococcal osteomyelitis of children, based mostly on retrospective analyses, comprise surgical drainage, up to 6 weeks of antimicrobials guided by the erythrocyte sedimentation rate, and the possibility of switching to the oral route only if monitoring of serum bactericidal titer is guaranteed. A prospective study was conducted to test whether the treatment could be simplified.

Design.  Fifty pediatric cases of acute Staphylococcus aureus osteomyelitis were randomized to receive 150 mg/kg/day of cephradine divided in four doses, or 40 mg/kg/day in four doses of clindamycin. The treatment was initiated intravenously, but switched to oral administration mostly within 4 days, using the same doses. The peak antimicrobial serum inhibitory titer or bactericidal titer was not measured. The course of illness was monitored by blood leukocytes, erythrocyte sedimentation rate, and serum C-reactive protein. The follow-up was extended to 1 year posthospitalization.

Setting.  Eight tertiary pediatric-orthopedic hospitals in Finland.

Main Outcome Measure.  Full recovery and remaining healthy at least 12 months from hospital discharge.

Results.  The lower and upper extremities were affected in 72% and 8% of patients, respectively. No surgery at all or needle aspiration only was performed in 62% and drilling in 38%. C-reactive protein and the sedimentation rate normalized within 9 days and 29 days, respectively. X-ray changes developed in 68% but had no prognostic significance. The mean hospitalization time was 11 days, and the total duration of antimicrobials was 23 days. No failure has occurred nor have long-term sequelae been observed in any patient.

Conclusions.  Treatment of pediatric acute staphylococcal osteomyelitis can be simplified and costs reduced by keeping surgery at a minimum, shortening hospitalization and the course of antimicrobials, switching quickly to the oral route, and not monitoring serum bactericidal activity.

Key words: osteomyelitis, childhood osteomyelitis, oral therapy of osteomyelitis, shortening therapy, serum bactericidal activity, C-reactive protein, Staphylococcus aureus..




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