Simplified treatment of acute staphylococcal osteomyelitis of childhood. The Finnish Study Group.
OBJECTIVE
Recommendations on treatment of acute staphylococcal osteomyelitis of children, based mostly on retrospective analyses, comprise surgical drainage, up to 6 weeks fo antimicrobials guided by the erythrocyte sedimentation rate, and the possibility of switching to the oral route only if monitoring of serum bactericidal titer is guaranteed. A prospective study was conducted to test whether the treatment could be simplified.


METHODS
Fifty pediatric cases of acute Staphylococcus aureus osteomyelitis were randomized to receive 150 mg/kg/day of cephradine divided in four doses, or 40 mg/kg/day in four doses of clindamycin. The treatment was initiated intravenously, but switched to oral administration mostly within 4 days, using the same doses. The peak antimicrobial serum inhibitory titer or bactericidal titer was not measured. The course of illness was monitored by blood leukocytes, erythrocyte sedimentation rate, and serum C-reactive protein. The follow-up was extended to 1 year posthospitalization.


METHODS
Eight tertiary pediatric-orthopedic hospitals in Finland.


METHODS
Full recovery and remaining healthy at least 12 months from hospital discharge.


RESULTS
The lower and upper extremities were affected in 72% and 8% of patients, respectively. No surgery at all or needle aspiration only was performed in 62% and drilling in 38%. C-reactive protein and the sedimentation rate normalized within 9 days and 29 days, respectively. X-ray changes developed in 68% but had no prognostic significance. The mean hospitalization time was 11 days, and the total duration of antimicrobials was 23 days. No failure has occurred nor have long-term sequelae been observed in any patient.


CONCLUSIONS
Treatment of pediatric acute staphylococcal osteomyelitis can be simplified and costs reduced by keeping surgery at a minimum, shortening hospitalization and the course of antimicrobials, switching quickly to the oral route, and not monitoring serum bactericidal activity.
Peltola
H
H
Division of Infectious Diseases, Helsinki University Central Hospital, Hospital for Children and Adolescents, Helsinki, Finland.
Unkila-Kallio
L
L
Kallio
M J
MJ
D000208:Acute Disease; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002515:Cephradine / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D002981:Clindamycin / Q000008:administration & dosage / Q000627:therapeutic use*; D004333:Drug Administration Routes; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007902:Length of Stay; D008297:Male; D010019:Osteomyelitis / Q000097:blood / Q000188:drug therapy* / Q000628:therapy; D011446:Prospective Studies; D015610:Serum Bactericidal Test; D013203:Staphylococcal Infections / Q000097:blood / Q000188:drug therapy* / Q000628:therapy
D000900:Anti-Bacterial Agents; D002981:Clindamycin; D002515:Cephradine