title: Trimethoprim-sulfamethoxazole therapy for children with acute osteomyelitis.
abstract: BACKGROUND
  The emergence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) has complicated the conventional management of osteomyelitis. While oral clindamycin is commonly used to treat acute CA-MRSA osteomyelitis, the emergence of inducible clindamycin resistance among CA-MRSA isolates has made alternative therapy necessary. The excellent oral bioavailability, susceptibility profile, favorable palatability, and low cost of trimethoprim-sulfamethoxazole (TMP-SMX) make this drug an attractive option for treating osteomyelitis, yet its clinical efficacy for osteomyelitis has not been established.
  
  
  METHODS
  Between October 1998 and September 2009, 20 children who received a TMP-SMX-containing regimen for acute osteomyelitis at All Children's Hospital were identified from hospital records, and their cases reviewed for clinical outcome and drug safety.
  
  
  RESULTS
  Patients ranged in age from 9 months to 17 years. Twelve (60%) of the patients were male. Causative pathogens were found in 8 (40%) cases of which 5 were CA-MRSA and 3 were methicillin-susceptible Staphylococcus aureus. Eleven patients (55%) received TMP-SMX as their primary therapy. The median dose of TMP-SMX was 16.4 mg/kg/d. During TMP-SMX therapy, 8 patients (40%) experienced adverse events; all were considered mild. Duration of total therapy was 26 to 59 days, with a median of 40 days. All 20 patients were considered cured of their infection at the end of therapy.
  
  
  CONCLUSIONS
  Orally administered TMP-SMX appears to be a useful and well-tolerated therapy for treatment of acute osteomyelitis in children. Further prospective comparative studies will be needed to confirm this observation.
authors.affiliation: Department of Pediatrics, Division of Infectious Diseases, All Children's Hospital/Johns Hopkins Medicine, Saint Petersburg, FL 33701, USA. allison.messina@allkids.org
authors.forename: Allison F
authors.initials: AF
authors.lastname: Messina
authors.forename: Katie
authors.initials: K
authors.lastname: Namtu
authors.forename: Michelle
authors.initials: M
authors.lastname: Guild
authors.forename: Juan A
authors.initials: JA
authors.lastname: Dumois
authors.forename: David M
authors.initials: DM
authors.lastname: Berman
mesh_terms: D000208:Acute Disease; D000284:Administration, Oral; D000293:Adolescent; D000890:Anti-Infective Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification; D010019:Osteomyelitis / Q000188:drug therapy* / Q000382:microbiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D000890:Anti-Infective Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination