The outcome of therapy of osteomyelitis in children

Abstract

From 1987 to 1994, 28 children were admitted to our hospital with a haematogenous osteomyelitis. They were evaluated by chart review for history, clinical presentation, diagnostic work-up, treatment and outcome. The patients were considered to have an acute (n=12) or a chronic osteomyelitis (n=16). The mean age was 5.5 years and 5.9 years, respectively. Clinical symptoms such as local tenderness and swelling were present for 8 and 128 days, respectively. The mean temperature at admission was 38.4 and 37.3°C, respectively. The ESR, CRP and WBC were elevated in children with an acute osteomyelitis. In chronic osteomyelitis cases these findings were less elevated. On the X-rays in 6 and 16 children, respectively, abnormalities were visible. All children underwent a surgical procedure: a cortical window was made, pus was drained and necrotic tissue was excised. Positive cultures were obtained in 9 and 7 children, respectively. Subsequently, all patients were treated with i.v. and oral antibiotics. The mean duration of i.v. plus oral antimicrobial therapy was 20 plus 22 days for acute osteomyelitis and 20 Plus 25 days for chronic osteomyelitis. The mean duration of hospitalisation was 23 days in both groups. The mean follow-up was 3.7 years for patients with an acute osteomyelitis and 2.7 years for patients with a chronic osteomyelitis. After treatment, all but one patients were clinically well and the infection parameters had returned to normal values. Three patients had residual signs (ankylosis, decreased function). After surgical intervention it appears that six weeks of antibiotic therapy is sufficient to eradicate acute as well as chronic osteomyelitis in children.