Shorter courses of parenteral antibiotic therapy do not appear to influence response rates for children with acute hematogenous osteomyelitis: a systematic review.

Nicole Le Saux,David Moher,Isabelle Gaboury,Nicholas J Barrowman,Andrew Howard,Margaret Sampson

doi:10.1186/1471-2334-2-16

Abstract

BackgroundAcute hematogenous osteomyelitis (AHO) occurs primarily in children and is believed to evolve from bacteremia followed by localization of infection to the metaphysis of bones. Currently, there is no consensus on the route and duration of antimicrobial therapy to treat AHO.MethodsWe conducted a systematic review of a short versus long course of treatment for AHO due primarily to Staphylococcus aureus in children aged 3 months to 16 years. We searched Medline, Embase and the Cochrane trials registry for controlled trials. Clinical cure rate at 6 months was the primary outcome variable, and groups receiving less than 7 days of intravenous therapy were compared with groups receiving one week or longer of intravenous antimicrobials.Results12 eligible prospective studies, one of which was randomized, were identified. The overall cure rate at 6 months for the short course of intravenous therapy was 95.2% (95% CI = 90.4, 97.7) compared to 98.8% (95% CI = 93.6, 99.8) for the longer course of therapy. There was no significant difference in the duration of oral therapy between the two groups.ConclusionsGiven the potential increased morbidity and cost associated with longer courses of intravenous therapy, this finding should be confirmed through a randomized controlled equivalence trial.

Highlights

Acute hematogenous osteomyelitis (AHO) occurs primarily in children and is believed to evolve from bacteremia followed by localization of infection to the metaphysis of bones
Group of osteomyelitis and septic arthritis could not be separated with respect to length of therapy or etiology
Since the total duration of antimicrobial therapy can affect the cure rate, we looked at the duration of oral therapy

Summary

Introduction

Acute hematogenous osteomyelitis (AHO) occurs primarily in children and is believed to evolve from bacteremia followed by localization of infection to the metaphysis of bones. AHO is believed to evolve from bacteremia followed by localization of infection to the metaphysis of bones. BMC Infectious Diseases 2002, 2 http://www.biomedcentral.com/1471-2334/2/16 duration of intravenous therapy ranges from 3 days to 4 to 6 weeks. One general pediatric textbook describes 7 days of parenteral therapy as standard, [4] whereas a pediatric infectious diseases textbook states that the usual duration of therapy is 4 to 8 weeks with a change to oral medication permissible when signs of local inflammation has resolved [5]. A standard orthopedic textbook suggests intravenous therapy for 5 days followed by oral therapy for 4 to 6 weeks for "typical" cases [6]

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Conclusion