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Summary The management of seventy-six children admitted to Aler Hey Children's Hospital with osteomyelitis is discussed and the indications for surgical intervention are defined. The clinical and pathological course of the disease is examined and the term post-acute osteomyelitis is introduced. The importance of recognition of this stage of the disease and its relevance to the management is highlighted. The use of single antibiotic therapy (clindamycin) is shown to be at least as effective as combinational therapy. Complete resolution was achieved in 94·7% of children, surgical intervention was performed on 74·6%.