Route and Length of Therapy of Acute Uncomplicated Hematogenous Osteomyelitis: Do We Have the Answers Yet?

Abstract

Acute hematogenous osteomyelitis (AHOM) is not uncommonly encountered in hospitalized pediatric patients, occurring in 1 in 5000 children per year or 1% of pediatric hospitalizations.1 There are published data regarding the length of antibiotic therapy, with many studies supporting an initial short intravenous (IV) course of therapy followed by an oral course of several weeks. Le Saux2 performed a systematic review that supported short-course IV therapy for AHOM. Peltola3 published the largest prospective study to date addressing treatment of AHOM, which supported short-course IV therapy followed by oral therapy for a total of 20 days. However, in practice, it is not so straightforward. It is not unusual for practitioners to recommend a long IV course of therapy, even in the face of an uncomplicated case of AHOM. Uncomplicated AHOM has been variably defined, but in general it would refer to osteomyelitis in a patient with <14 days of symptoms, no underlying medical conditions, and infection not associated with trauma and not requiring extensive surgical intervention3–6. This review synthesizes the available literature and addresses 2 clinical questions: (1) Is it reasonable to use short-course IV therapy in uncomplicated AHOM in pediatric patients? and (2) What is the appropriate total duration of therapy for uncomplicated AHOM in pediatric patients? AHOM is defined as <2 weeks of clinical symptoms with associated laboratory and imaging findings characteristic of AHOM and without any source for exogenous spread to the bone, such as may occur with penetrating trauma. The Pub Med and Google Scholar databases were used to conduct searches. Google Scholar was used to aid in finding open-access articles that might not be listed in PubMed. The search followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.7 Google scholar search terms included “osteomyelitis …