Antibiotic Treatment and Surgery for Acute Hematogenous Calcaneal Osteomyelitis of Childhood.
Acute hematogenous calcaneal osteomyelitis characteristically affects children. A recent trend has emerged toward shorter courses of antibiotics. In our randomized, prospective treatment trial of children aged 3 months to 15 years, the intravenous antibiotic (clindamycin or a first-generation cephalosporin) was given only for the first 2 to 4 days and the remainder of the 20- to 30-day course was completed orally. A bone sample for culture was to be taken routinely, but all additional surgery was performed on special demand. We performed a retrospective subanalysis of cases affecting the calcaneus. The follow-up period was 1 year. Of the 14 participants enrolled, 11 completed the 1-year follow-up period, and their data were analyzed. Staphylococcus aureus was the cause of 10 cases; all strains were methicillin sensitive. The median intravenous treatment duration was 3 days. Four patients required open incisional trepanation (trephination). All participants attending the 1-year follow-up examination had fully recovered. The outcome of calcaneal osteomyelitis caused by methicillin-sensitive S. aureus in a child will be good, if the patient seeks treatment early and antibiotic therapy is started promptly. A bone biopsy is needed to obtain a representative sample for bacteriology.
Surgeon, Division of Diseases of the Musculoskeletal System, Turku University Hospital and the University of Turku, Turku, Finland; Surgeon, Department of Hand and Microsurgery, Tampere University Hospital, Tampere, Finland. Electronic address: Markus.Paakkonen@helsinki.fi.
Markus
M
Pääkkönen
Assistant Professor, University of Helsinki and Children's Hospital, Helsinki University Central Hospital, Helsinki, Finland.
Markku J T
MJ
Kallio
Professor, University of Helsinki and Children's Hospital, Helsinki University Central Hospital, Helsinki, Finland.
Heikki
H
Peltola
Assistant Professor, University of Helsinki and Children's Hospital, Helsinki University Central Hospital, Helsinki, Finland.
Pentti E
PE
Kallio
D000208:Acute Disease; D000284:Administration, Oral; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000382:microbiology / Q000628:therapy*; D002111:Calcaneus / Q000187:drug effects / Q000473:pathology* / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D002981:Clindamycin / Q000627:therapeutic use; D004322:Drainage / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007262:Infusions, Intravenous; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D010019:Osteomyelitis / Q000382:microbiology / Q000503:physiopathology / Q000628:therapy*; D019990:Perioperative Care / Q000379:methods; D011446:Prospective Studies; D018570:Risk Assessment; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000628:therapy; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D002981:Clindamycin
antimicrobial; aspiration; calcaneus; child; trepanation