SLR - June 2015 - Rajnish Rammohan
Reference: Peltola H, Paakkonnen M. Acute osteomyelitis in children. N Engl J Med. 2014 Jan 23;370(4):352-60.Scientific Literature Review
Reviewed By: Rajnish Rammohan, DPM
Residency Program: Southern Arizona VA Health Care System
Podiatric Relevance: As specialists in the foot and ankle, podiatric surgeons are exposed to numerous pathologies involving painful gait. Children with acute osteomyelitis often present with a classic manifestation of limping and an inability to walk. Therefore it is of benefit for the podiatric physician to educate oneself in recognizing and treating possible acute osteomyelitis in pediatric patients. This article provides an overview of some of the common pathogens and discusses treatment plans by providing antibiotic treatment guidelines and discusses role of surgical intervention thereby assisting the podiatric physician in decision making and so serves as a helpful tool for the podiatric physician in managing and treating the pediatric patient.
Methods: In an effort to effectively assess duration of treatment as well as to determine when to switch from oral to IV antibiotic therapy, the following trials were carried out. A prospective randomized trial was performed comparing a 20 day regime of high dose clindamycin or a first generation cephalosporin to a 30 day regime for osteomyelitis caused by Methicillin Susceptible Staphylococcus Aureus (MSSA). In order to determine the timeline of switching from prolonged intravenous antibiotic treatment versus oral antibiotic therapy, the authors conducted a prospective study involving 131 children who had active osteomyelitis with Methicillin Susceptible Staphylococcus Aureus (MSSA) older than 3 months of age. Intravenous antibiotics were administered for two to four days followed by oral administration as compared to the traditional treatment of receiving intravenous medications for weeks.
Results: The authors determined based on the trials carried out that a 20 day regime of high dose clindamycin or a first generation cephalosporin performed as well as a 30 day regime for osteomyelitis caused by Methicillin Susceptible Staph Aureus (MSSA). To determine if early switching to an oral antibiotic therapy is beneficial based on the perspective studies the authors found no new outbreaks after switching patients to oral treatments after two to four days of intravenous antibiotic therapy.
Conclusions: This article provides an overview for diagnosis of osteomyelitis in children, compares the results of utilizing serum markers to assess response to treatment, CRP versus ESR. It also discusses the benefits of utilizing MRI versus CT scan and provides a guideline for management utilizing antibiotics and discusses duration of treatment and compares route of administration and response to treatment and concludes with an interesting case report. It is important to recognize and treat acute osteomyelitis in children as the resulting sequela from the infection can cause growth disturbance. It is important to recognize and understand the treatment methodologies to achieve favorable outcomes.