Acute infectious osteomyelitis in children: new treatment strategies for an old enemy
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REVIEW ARTICLE
Acute infectious osteomyelitis in children: new treatment strategies for an old enemy Sabrina Congedi1 · Chiara Minotti1 · Carlo Giaquinto2 · Liviana Da Dalt3 · Daniele Donà2 Received: 3 August 2019 / Accepted: 17 March 2020 © Children’s Hospital, Zhejiang University School of Medicine 2020
Abstract Background Acute osteomyelitis still represents a significant clinical challenge, with an increasing incidence in paediatric population. A careful assessment and a rapid diagnosis with proper timing and choice of empirical antimicrobial therapy are necessary to avoid sequelae. The initial treatment should consist of empirical antibiotic therapy, to cover the major responsible pathogens in each age group. Data sources We made a literature search with PubMed and Cochrane database from 2000 to 2019 in English, French, and Spanish languages using the key words “osteomyelitis, children, clinical, diagnosis, and treatment”. Results The child’s clinical features, age, and the microbiological profile of the geographic area should be evaluated for diagnosis and in the choice of antibiotic treatment. Latest data suggest the administration of intravenous antibiotics for a short period, with subsequent oral therapy, according to the improvement of clinical status and inflammatory markers. For children older than 3 months, the shift to oral medications is already possible after a short course of intravenous therapy, until recovery. The timing for the shift from cefazolin to cephalexin or cefuroxime, intravenous clindamycin to oral clindamycin, and intravenous ceftriaxone + oxacillin to oral equivalents will be decided according to the improvement of clinical status and inflammatory markers. We also present the approach to osteomyelitis due to difficult pathogens, such as Methicillin-resistant Staphylococcus aureus (MRSA) and Panton-Valentine leukocidin (PVL)-positive S. aureus infections. Conclusion In this review, we present the current approach to the clinical diagnosis and management of osteomyelitis in childhood, with an update on recent recommendations, as a useful instrument to understand the rationale of antibiotic therapy. Keywords Acute osteomyelitis · Children · Diagnosis · Treatment
Introduction Osteomyelitis is the infection of bone determined by pathogenic microorganisms and it represents the most widespread musculoskeletal infection in childhood [1]. Young children are especially affected, with 50% of patients under 5 years, where male are struck twice as much as female, apparently due to a higher susceptibility to microtrauma. Mainstays * Chiara Minotti [email protected] 1
Department of Women’s and Children’s Health, University of Padua, Padua, Italy
2
Division of Paediatric Infectious Diseases, Department of Women’s and Children’s Health, University of Padua, Padua, Italy
3
Paediatric Emergency Department, Department of Women’s and Children’s Health, University of Padua, Padua, Italy
of the management of acute osteomyelitis in children are a rapid identification and start
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