Abstract
Purpose of study: Septic arthritis and osteomyelitis have traditionally been managed by intravenous antibiotics for 3 to 6 weeks. This requires a prolonged in patient stay, inconvenience to parents, morbidity and cost. A number of authors have suggested that a shortened course of intravenous antibiotics for 7–10 days may be as effective.
This studies reviews the outcomes of a short course regime started in 2001.
Methods: We prospectively reviewed 34 cases of acute osteomyelitis and 28 cases of acute septic arthritis in children. These were confirmed by a positive blood culture or a positive aspirate culture or raised WCC in joint aspirate for septic arthritis; or a positive bone scan/culture for osteomyelitis.
Patients were treated with a 3 day course of intravenous antibiotics, following surgical drainage of joints when required. Providing the clinical and biochemical parameters were improving patients then received 3 weeks oral antibiotics.
The duration of IV administration and of inpatient stay and any incidence of readmission/reoccurrence was noted. Serial measurements of inflammatory markers were recorded.
Results: 35 of the 62 patients received intravenous antibiotics for < 4 days. Mean in-patient stay was 5.5 days. There was one re-admission for recurrence of infection. One patient required a repeat joint washout at 7 days. At 3 months no patients had ongoing infection. There was a correlation between CRP levels and the severity of infection, and therefore the length of treatment required.
Conclusions: We suggest acute suppurative skeletal infection can be managed safely with a shortened course of intravenous and oral antibiotics (following surgical drainage in the case of intra articular infection). Patients must be observed closely by experienced practitioners.
Correspondence should be addressed to: Mr J. B. Hunter, BSCOS, c/o BOA, The Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PE.
