Systematic review of systemic antibiotic treatment for children with chronic and sub-acute pyogenic osteomyelitis.
BACKGROUND
There is a lack of consensus on the most appropriate antibiotics to treat children with chronic or sub-acute pyogenic bacterial osteomyelitis and on the optimal duration of antibiotic therapy.


OBJECTIVE
To review the published evidence on the duration of antibiotic therapy and outcomes in children with chronic and sub-acute pyogenic bacterial osteomyelitis.


METHODS
Systematic review of the literature.


RESULTS
We found no randomised controlled trials comparing different antibiotic regimens or comparing duration of antibiotic treatment for chronic or sub-acute osteomyelitis in children. We found 14 observational case series published between 1973 and 2008. Most children with chronic osteomyelitis received 4-6 weeks of parenteral antibiotics followed by oral antibiotics to a total duration of 3-6 months. Small observational studies suggest that a shorter duration of parenteral and oral antibiotics may be equally effective.


CONCLUSIONS
There is no high level evidence on the optimal duration of parenteral and oral antibiotics for children with chronic or sub-acute osteomyelitis. A large randomised controlled trial is needed comparing short course parenteral and oral antibiotics with longer antibiotic duration.
Howard-Jones
Annaleise R
AR
Faculty of Medicine, University of Sydney, Sydney, and Children's Hospital at Westmead, Westmead, NSW 2145, Australia.
Isaacs
David
D
D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008297:Male; D010019:Osteomyelitis / Q000188:drug therapy*; D013492:Suppuration / Q000188:drug therapy
D000900:Anti-Bacterial Agents