Introduction and Aims: The appropriate duration of antibiotic therapy in children suffering from acute haematogenous osteomyelitis (AHO) and acute septic arthritis (SA) has not been clearly established by clinical trials. In recent years there has been a tendency to shorter courses of both intravenous and oral therapy, but evidence is currently limited as to the efficacy of short duration antimicrobial therapy. .
Method: This study was conducted in two phases.
A retrospective study of 71 children in which we investigated the duration of both intravenous and oral antimicrobial therapy in relation to recurrent disease and side effects.
A prospective study, now underway investigating the efficacy of a combined short IV (three days)/short oral (three weeks) combination of antibiotics in children with acute osteomyelitis and acute septic arthritis.
Results: Duration of antibiotics in the retrospective study varied from two to 28 days with a median duration of 4.5 days. Duration of the oral phase of antibiotic therapy varied from two to 10 weeks with a median value of 4.7 weeks. The recurrence rate, requiring admission or an additional operative procedure was 1.4%. There were no long-term sequelae.
In the prospective study the duration of intravenous and oral antibiotics has been successfully reduced in the majority of patients, without any increase in the need for surgical procedures, re-admission or evidence of chronic osteomyelitis. However, in 26% of patients, the duration of the IV phase of antibiotic therapy was electively increased, because of clinical signs, suggestive of inadequate response. To date recurrent/chronic disease has only been seen in patients judged clinically to have an inadequate response to short-term therapy and who received a longer course of IV antibiotics.
Conclusion: Shorter courses of antimicrobial therapy in children with acute haematogenous osteomyelitis and acute septic arthritis, are safe and effective with a low incidence of recurrent disease. However clinical judgment is required to identify those children who require longer courses of both intravenous and oral therapy in order to eradicate the disease during the primary presentation. Further study is required to identify with greater certainty the profile of children who require longer courses of therapy than the emerging standard, three weeks IV/three weeks oral.
