Antibiotics in Acute Osteomyelitis in Children

Abstract

1. Continued follow-up of the 113 children with acute osteomyelitis previously reported and a study of a further thirty-eight proven cases has not changed our opinion that the correct management is rest and effective antibiotics. Operation should be undertaken only if pus is detectable clinically. 2. Bacteriological evidence shows that the flora causing this disease are less sensitive to benzylpenicillin than ten years ago and that a proportion are also likely to become resistant to methicillin and cloxacillin. 3. The most effective antibiotic combination used was fusidic acid and erythromycin. This lowered the failure rate to 10·5 per cent in thirty-eight proven cases. Two of the four failures were in haemophilus infections. No staphylococcal infection of a long bone became chronic, and all lesions were healed within three months of onset. 4. The duration of treatment (twenty-one days) and the method of splintage (removable plaster slabs) remained the same as in the previous series. 5. Careful watch must be kept on the incidence of haemophilus infections. If it rises, increasing the erythromycin or adding ampicillin may be necessary. 6. Use of the newer aqueous suspension of fusidic acid may lower the incidence of troublesome vomiting (12 per cent in this series). 7. Only 7 per cent of staphylococcus aureus infections in this hospital, and 17 per cent of such infections in our thirty-eight cases were sensitive to benzylpenicillin. It is thought that this drug has outlived its usefulness in osteomyelitis. 8. It is recommended that, on diagnosis, fusidic acid aqueous suspension 5 millilitres should be given three times a day to children aged one to five, and 10 millilitres twice a day for children aged six to twelve, with erythromycin stearate 30 milligrams per kilogram of body weight each day in divided doses.

Pediatric Acute Hematogenous Osteomyelitis

“…This is in accordance with previous results reporting its occurrence ranging between 48% and 94% in various populations. 6,7,11,[16][17][18][19]26,27 We only had 1 case of H. influenzae type B and attribute this to the introduction of the vaccination, which has essentially led to its eradication, as previously reported. 28 The emergence of MRSA over the past few years as a responsible pathogen for musculoskeletal infection has been well described around the world.…”

“…17,26,34,35 The antibiotic regimen for the treatment of AHO needs to be tailored for each institution. In Gillespie and Mayo's 4 study, spanning the first 30 years of the "antibiotic era," penicillin and erythromycin were the main antibiotics used to combat predominantly S. aureus infections.…”

“…4,6,7,11,16,17,26,34 Gillespie and Mayo 4 reported a recurrence rate of 17%, most of which occurred within the first year of the initial illness. Other complications of AHO reported include pathologic fracture, growth disturbance, local extension to soft tissues, involvement of an adjacent joint, and occasionally death.…”

Ciprofloxacin concentrations in bone and muscle after oral dosing

“…Orally administered antibiotics, such as cloxacillin, dicloxacillin, fusidic acid, and clindamycin, have been used in patients with acute and chronic staphylococcal osteomyelitis, usually after short-term parenteral therapy, -with good or reasonably good results (2,3,7). However, data on oral therapy for gram-negative or mixed bacterial osteomyelitis are sparse.…”

The management of childhood osteomyelitis

“…Wharton and Beddow (1975) of Alder Hey reported a primary healing rate of 94-2% but their operative rate was 89% as opposed to 50%. in Blockey's 1972 series and 74-6% in this series. Wharton also used clindamycin and it is worthy of note, in view of McAllister's findings of emergence of resistant strains of Staph.…”