title: Simplified treatment of acute staphylococcal osteomyelitis of childhood. The Finnish Study Group.
abstract: 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.
authors.affiliation: Division of Infectious Diseases, Helsinki University Central Hospital, Hospital for Children and Adolescents, Helsinki, Finland.
authors.forename: H
authors.initials: H
authors.lastname: Peltola
authors.forename: L
authors.initials: L
authors.lastname: Unkila-Kallio
authors.forename: M J
authors.initials: MJ
authors.lastname: Kallio
mesh_terms: 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
chemical_list: D000900:Anti-Bacterial Agents; D002981:Clindamycin; D002515:Cephradine