title: Acute haematogenous osteomyelitis in children: is there any evidence for how long we should treat?
abstract: OBJECTIVE
  Despite diagnostic and therapeutic advances, acute haematogenous osteomyelitis in children continues to cause significant morbidity and disease burden. The molecular epidemiology of causal organisms has wide geographic variation, but regardless of cause children often require several weeks of inpatient parenteral antibiotic therapy. This review focuses on antibiotic treatment and length of antibiotic therapy.
  
  
  RESULTS
  Currently there is no international and little local consensus regarding the route or duration for antibiotic treatment of acute haematogenous osteomyelitis in children. Although there are encouraging data from review papers and case series, no randomized controlled trial has been conducted to show good evidence for shorter courses of parenteral antibiotic treatment. Prospective studies show effective treatment for a wide variety of antibiotic agents, but there are few comparative studies. Overall treatment for 4-6 weeks is considered standard therapy, but the laboratory or clinical parameters that would determine the decision to switch to oral therapy remain undefined.
  
  
  CONCLUSIONS
  Evidence-based data about the route and duration of intravenous antibiotic treatment for acute haematogenous osteomyelitis in children are still limited to observational and retrospective studies. A randomized controlled trial will provide much needed data.
authors.affiliation: Paediatric Infectious Diseases Unit, St George's Hospital, London, UK. stefen.weichert@stgeorges.nhs.uk
authors.forename: Stefan
authors.initials: S
authors.lastname: Weichert
authors.forename: Mike
authors.initials: M
authors.lastname: Sharland
authors.forename: Nicholas M P
authors.initials: NM
authors.lastname: Clarke
authors.forename: Saul N
authors.initials: SN
authors.lastname: Faust
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004334:Drug Administration Schedule; D004838:Epiphyses / Q000382:microbiology / Q000503:physiopathology; D006801:Humans; D010019:Osteomyelitis / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents