ANTIBIOTIC TREATMENT FOR OSTEOMYELITIS, SEPTIC ARTHRITIS AND PYOMYOSITIS

Key words: Osteomyelitis, Septic arthritis, Pyomyositis, Audit, Antibiotic treatment, Children

Evidence for the choice or duration of antibiotic treatment for bone, joint infections and pyomyositis is scarce and no randomised trials (RCT) have been done in children and adolescents. The recommendations contained in this work come from the audit on the management of children with osteomyelitis, septic arthritis and pyomyositis hospitalized at the Institute for Child Health “Burlo Garofolo”, Trieste, Italy in the last 8 years. The antibiotic regimen should be based on likelihood of the organisms involved and current local sensitivity patterns, modified subsequently by results of Gram stain and culture. Because probable pathogen in all risk groups is Staphylococcus aureus, initial antibiotic treatment should have bactericidal activity against this bacterium. Suitable choices include β-lactamase-stable penicillins (such as oxacillin and similar) for the treatment of bone and joint infections (with the exception of newborns). For the cases of pyomyositis, findings of studies have consistently showed a worrying increase in meticillin-resistant Staphylococcus aureus infection and the choice of vancomicin or clindamycin seems to be reasonable. As to the duration of the treatment, 4 RCT on paediatric patients reported that the shorter courses of parenteral antibiotic therapy do not appear to influence response rates for children with acute hematogenous osteomyelitis.