Pediatric Osteoarticular Infections Treatment Guide
Treatment options for pediatric osteoarticular infections including common organisms, appropriate antibiotics, IV vs. PO therapy, oral treatment options, and follow-up recommendations. Enhance your understanding of managing these infections in children.
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Treatment of pediatric osteoarticular infections Benjamin Westley MD FAAP FACP FIDSA September 24, 2021
Organisms seen MRSA and MSSA Haemophilus influenzaea (under 5 years) Streptococcus pyogenes Streptococcus pneumoniae Kingellakingae(younger children) Rare: Brucella, salmonella, TB, E coli
Different drugs for different bugs MRSA -> vancomycin MSSA -> cefazolin Haemophilus influenzae -> ceftriaxone Group A streptococcus -> ampicillin Cultures of blood prior to antibiotics Cultures of joint fluid or bone prior to antibiotics If toxic, antibiotics should not be witheld
ANMC Pediatric Acute HematogenousSeptic Arthritis/Osteomyelitis guideline
IV vs. PO Prior to 1980s, prolonged IV therapy (6-8 weeks) common Nelson Lancet 1988: IV switch to oral effective Peltola Peds ID J 2010: Courses as short at 3 weeks for MSSA may be effective Arnold Pediatrics 2012: Use of CRP <3 mg/dL, afebrile, and able to bear weight for transition to PO >99% success If CRP does not fall below 5 mg/dL, suggests inadequate source control Exact duration of therapy not well described We use combination of clinical, laboratory, and radiographic features
Oral therapy options MRSA -> clindamycin 30-40 mg/kg/day divided TID MSSA -> cephalexin 100 mg/kg/day divided TID Group A strep -> amoxicillin 100 mg/kg/day divided TID H flu -> amox/clav100 mg/kg/day divided TID Multiple considerations for swap to PO and drug selection Consult pedsID provider
Treatment follow up CBC, ESR, CRP at 3 weeks (and 6 weeks if OM) XR at end of therapy to confirm no e/oongoing bone infection or r/ounrecognized OM Small % of OM may have normal MR at time of acute presentation ESR <20, CRP <1 at time of abxwithdrawal >99% success Coordination between orthopedics, pediatrics, and pediatric ID essential to ensure medication compliance and adequate follow-up
Risks if treatment failure All very rare in modern antimicrobial era Avascularnecrosis Pathologic fracture Growth plate injury, limb length discrepancy DVT/septic thrombosis Vertebral body kyphosis/collapse Relapsed infection/chronic OM
References Arnold Infect DisClinN Am 29 (2015) 557 574 PeltolaClin Infect Dis 2009;48(9):1201 10. PaakkonenN EnglJ Med 2014;370(14):1365 6. Peltola Pediatr Infect Dis J 2010;29(12):1123 8. SyrogiannopoulosLancet 1988;1(8575 6):37 40. Feigin Pediatrics 1975;55(2):213 23. Arnold Pediatrics 2012;130(4):e821 8. ZaoutisPediatrics 2009;123(2):636 42.
