Acute hematogenous osteomyelitis in childhood--correlation of clinical aspects, diagnostic parameters, therapy and prognosis

Abstract

Acute hematogenous osteomyelitis is a common disease in childhood. If treated early, conservative management is possible in most cases. During recent decades, clinical picture, diagnostic techniques and treatment have changed due to various reasons, e.g. previous antibiotic treatment. New laboratory tests and improved imaging techniques such as magnetic resonance imaging enable an earlier diagnosis and thus an earlier onset of treatment and improve the prognosis of hematogenous osteomyelitis. Outcome has also been improved by new antibiotics with enhanced activity against staphylococci. The records of 34 children aged 3 weeks to 172 months with acute hematogenous osteomyelitis were evaluated retrospectively. In some cases, the data were completed by phone calls with parents and family physicians. The results were compared with the current literature. If diagnosed and treated early, acute hematogenous osteomyelitis in childhood has a good prognosis. For primary diagnosis, the clinical picture, parameters of inflammation and magnetic resonance imaging or scintigraphy are useful. The course of the disease can be assessed by clinical signs and the erythrocyte sedimentation rate. Complications can be recognized by conventional radiography and sonography. Initial antibiotic treatment should be carried out parenterally for at least 3 weeks. An exclusively oral treatment is not recommended.