Outpatient Antibiotic Therapy for Acute Osteomyelitis in Children

Milstone, Aaron M.

doi:10.1001/jamapediatrics.2014.2850

Cited by 5 publications

(4 citation statements)

References 9 publications

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“…Faust et al [ 33 ], on the other hand, recommend much lower oral doses. Moreover, the successful use of trimethoprim/sulfamethoxazole (TMP/SMX) for oral treatment of MRSA acute osteomyelitis has been reported from the U.S. [ 36 ]. At our institution we switch to oral therapy after 5–7 days if course is favorable, using the highest recommended doses.…”

Section: Update On Therapeutic Managementmentioning

confidence: 99%

A Case of Acute Osteomyelitis: An Update on Diagnosis and Treatment

Chiappini

Mastrangelo

Lazzeri

2016

IJERPH

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Osteomyelitis in children is a serious disease in children requiring early diagnosis and treatment to minimize the risk of sequelae. Therefore, it is of primary importance to recognize the signs and symptoms at the onset and to properly use the available diagnostic tools. It is important to maintain a high index of suspicion and be aware of the evolving epidemiology and of the emergence of antibiotic resistant and aggressive strains requiring careful monitoring and targeted therapy. Hereby we present an instructive case and review the literature data on diagnosis and treatment.

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Section: Update On Therapeutic Managementmentioning

confidence: 99%

A Case of Acute Osteomyelitis: An Update on Diagnosis and Treatment

Chiappini

Mastrangelo

Lazzeri

2016

IJERPH

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“…Administrative "big data" can have big trade-offs of incompleteness. 11 Despite propensity scoring, patients treated orally may have had predictably better outcomes, e.g., no bacteriologic confirmation in 50% treated orally versus 35% treated intravenously, MSSA 29% versus 38%, MRSA 14% versus 19% and osteotomy performed in 35% versus 42%, respectively. There also was uneven distribution of treatment across hospitals, with some "almost never" and some "almost always" choosing oral mode of therapy.…”

Section: Therapy Of Acute Osteomyelitismentioning

confidence: 99%

Optimizing antimicrobial therapy in children

Long

2016

Journal of Infection

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Management of common infections and optimal use of antimicrobial agents are presented, highlighting new evidence from the medical literature that enlightens practice. Primary therapy of staphylococcal skin abscesses is drainage. Patients who have a large abscess (>5 cm), cellulitis or mixed abscess-cellulitis likely would benefit from additional antibiotic therapy. When choosing an antibiotic for outpatient management, the patient, pathogen and in vitro drug susceptibility as well as tolerability, bioavailability and safety characteristics of antibiotics should be considered. Management of recurrent staphylococcal skin and soft tissue infections is vexing. Focus is best placed on reducing density of the organism on the patient's skin and in the environment, and optimizing a healthy skin barrier. With attention to adherence and optimal dosing, acute uncomplicated osteomyelitis can be managed with early transition from parenteral to oral therapy and with a 3-4 week total course of therapy. Doxycycline should be prescribed when indicated for a child of any age. Its use is not associated with dental staining. Azithromycin should be prescribed for infants when indicated, whilst being alert to an associated ≥2-fold excess risk of pyloric stenosis with use under 6 weeks of age. Beyond the neonatal period, acyclovir is more safely dosed by body surface area (not to exceed 500 mg/m(2)/dose) than by weight. In addition to the concern of antimicrobial resistance, unnecessary use of antibiotics should be avoided because of potential later metabolic effects, thought to be due to perturbation of the host's microbiome.

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“…The transition from intravenous to oral antimicrobial therapy remains debatable. There is a growing literature advocating a shorter course of IV antibiotics, followed by oral antibiotics [24][25][26][27][28]. In this study, inflammatory markers changed faster in the surgical group, and a shorter course of IV antibiotic therapy was implemented in the surgical group.…”

Section: Discussionmentioning

confidence: 85%

Is Early Surgical Intervention Necessary for Acute Neonatal Humeral Epiphyseal Osteomyelitis: A Retrospective Study of 31 Patients

et al. 2022

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Objective: To review the treatment experience of neonatal humeral epiphyseal osteomyelitis retrospectively. Study design: Retrospective cohort study of infants with neonatal humeral epiphyseal osteomyelitis. Patients were divided into conservative group and surgical group, and the surgical group was subdivided into early and delayed surgical group. Results: In total, there were 7 patients in the conservative group and 24 in the surgical group. The length of hospital stay and intravenous course of antibiotic therapy were both significantly shorter in the surgical group (p < 0.001). The full recovery rate was also higher in the surgical group (83.3%) than the conservative group (14.3%) (p < 0.001). Early surgery group (n = 14) had an insignificantly higher positive rate of pus/aspirate culture and full recovery rate than delayed surgery group (n = 10). Conclusion: Surgical treatment for neonatal humeral epiphyseal osteomyelitis demonstrated significantly higher rates of positive culture for the pathogen, a shorter course of intravenous oral antibiotics, and lower incidence of growth abnormality than conservative treatment. In our institution, most of culture outcome Gram-positive bacteria, and early surgical treatment was recommended with better outcome than delayed surgical group. Empirical antibiotics should be tailored to the epidemiological characteristics of local virulent bacteria.

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Outpatient Antibiotic Therapy for Acute Osteomyelitis in Children

Cited by 5 publications

References 9 publications

A Case of Acute Osteomyelitis: An Update on Diagnosis and Treatment

A Case of Acute Osteomyelitis: An Update on Diagnosis and Treatment

Optimizing antimicrobial therapy in children

Is Early Surgical Intervention Necessary for Acute Neonatal Humeral Epiphyseal Osteomyelitis: A Retrospective Study of 31 Patients

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