EBM Review: Comparative effectiveness of intravenous vs. oral antibiotics for postdischarge treatment of acute osteomyelitis in children.

Keren R, Shah SS, Srivastava R, et al. Comparative effectiveness of intravenous vs. oral antibiotics for postdischarge treatment of acute osteomyelitis in children. JAMA Pediatr. 2015 Feb;169(2):120-8.

Reviewed by:

Damon Jones, MD Damon Jones, MD PGY-3

Jane Stremming, MD Jane Stremming, MD PGY-3

Background:

  • Osteomyelitis is a relatively uncommon infection in pediatrics
    • Incidence of about 2 – 13/100,000 in developed countries, higher in developing countries
  • Mean age of diagnosis is 6.6 years
    • 40% occur in pre-school aged children
  • Male: Female 1.82:1
  • Risk factors include blunt trauma (30%) and recent systemic infection (37%)
    • No identified risk factors in nearly half of all cases (47%)
  • Presenting symptoms include pain (81%), localized signs symptoms (70%), fever (62%), reduced ROM (50%), and reduced weight bearing (50%)
  • ESR and CRP usually elevated on presentation (91 and 81%, respectively)
    • WBC elevated in only 36% of cases

Continue reading