title: Simplifying the treatment of acute bacterial bone and joint infections in children.
abstract: The treatment of acute hematogenous bone and joint infections of children - osteomyelitis (OM), septic arthritis (SA) and OM-SA combination (OM+SA) - has simplified over the past years. The old approach included months-long antibiotic treatment, started intravenously for at least a week, followed by oral completion of the course. Recent prospective randomized trials show that most cases heal with a total course of 3 weeks (OM, OM+SA) or 2 weeks (SA) of an appropriate antibiotic, provided the clinical response is good and C-reactive protein level has normalized. If the prevalence of methicillin-resistant Staphylococcus aureus and Kingella kingae is low, clindamycin and a first-generation cephalosporin are safe, inexpensive and effective alternatives. They should be administered in large doses and four times a day. Clindamycin, vancomycin and expensive linezolid are options against methicillin-resistant Staphylococcus aureus. Extensive surgery beyond a diagnostic sample by aspiration is rarely needed in uncomplicated cases.
authors: University of Helsinki, and Children's Hospital, Helsinki University Central Hospital, Helsinki, Finland. markus.paakkonen@helsinki.fi
authors: Markus
authors: M
authors: Pääkkönen
authors: Heikki
authors: H
authors: Peltola
mesh_terms: D000081:Acetamides / Q000008:administration & dosage / Q000627:therapeutic use; D000208:Acute Disease; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D001170:Arthritis, Infectious / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D001842:Bone and Bones; D002097:C-Reactive Protein / Q000032:analysis; D002648:Child; D002675:Child, Preschool; D002981:Clindamycin / Q000008:administration & dosage / Q000627:therapeutic use; D004334:Drug Administration Schedule; D005387:Finland; D006801:Humans; D007596:Joints; D017882:Kingella kingae / Q000187:drug effects* / Q000254:growth & development; D000069349:Linezolid; D016106:Methicillin Resistance / Q000187:drug effects; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects* / Q000254:growth & development; D016870:Neisseriaceae Infections / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D010019:Osteomyelitis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D023303:Oxazolidinones / Q000008:administration & dosage / Q000627:therapeutic use; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D013203:Staphylococcal Infections / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D014640:Vancomycin / Q000008:administration & dosage / Q000627:therapeutic use
chemical_list: D000081:Acetamides; D000900:Anti-Bacterial Agents; D023303:Oxazolidinones; D002981:Clindamycin; D014640:Vancomycin; D002097:C-Reactive Protein; D000069349:Linezolid