Shorter courses of parenteral antibiotic therapy do not appear to influence response rates for children with acute hematogenous osteomyelitis: a systematic review.
BACKGROUND
Acute hematogenous osteomyelitis (AHO) occurs primarily in children and is believed to evolve from bacteremia followed by localization of infection to the metaphysis of bones. Currently, there is no consensus on the route and duration of antimicrobial therapy to treat AHO.


METHODS
We conducted a systematic review of a short versus long course of treatment for AHO due primarily to Staphylococcus aureus in children aged 3 months to 16 years. We searched Medline, Embase and the Cochrane trials registry for controlled trials. Clinical cure rate at 6 months was the primary outcome variable, and groups receiving less than 7 days of intravenous therapy were compared with groups receiving one week or longer of intravenous antimicrobials.


RESULTS
12 eligible prospective studies, one of which was randomized, were identified. The overall cure rate at 6 months for the short course of intravenous therapy was 95.2% (95% CI = 90.4 - 97.7) compared to 98.8% (95% CI = 93.6, 99.8) for the longer course of therapy. There was no significant difference in the duration of oral therapy between the two groups.


CONCLUSIONS
Given the potential increased morbidity and cost associated with longer courses of intravenous therapy, this finding should be confirmed through a randomized controlled equivalence trial
Le Saux
Nicole
N
Department of Pediatrics, University of Ottawa, Ontario, Canada. lesaux@cheo.on.ca
Howard
Andrew
A
Barrowman
Nicholas J
NJ
Gaboury
Isabelle
I
Sampson
Margaret
M
Moher
David
D
D000208:Acute Disease; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000627:therapeutic use*; D015331:Cohort Studies; D006801:Humans; D007263:Infusions, Parenteral / Q000379:methods*; D010019:Osteomyelitis / Q000188:drug therapy* / Q000209:etiology; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D013203:Staphylococcal Infections / Q000150:complications / Q000188:drug therapy*; D013211:Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents