Abstract
The treatment of acute hematogenous bone and joint infections of children - osteomyelitis (OM), septic arthritis (SA) and OM-SA combination (OM+SA) - has simplified over the past years. The old approach included months-long antibiotic treatment, started intravenously for at least a week, followed by oral completion of the course. Recent prospective randomized trials show that most cases heal with a total course of 3 weeks (OM, OM+SA) or 2 weeks (SA) of an appropriate antibiotic, provided the clinical response is good and C-reactive protein level has normalized. If the prevalence of methicillin-resistant Staphylococcus aureus and Kingella kingae is low, clindamycin and a first-generation cephalosporin are safe, inexpensive and effective alternatives. They should be administered in large doses and four times a day. Clindamycin, vancomycin and expensive linezolid are options against methicillin-resistant Staphylococcus aureus. Extensive surgery beyond a diagnostic sample by aspiration is rarely needed in uncomplicated cases.
MeSH terms
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Acetamides / administration & dosage
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Acetamides / therapeutic use
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Acute Disease
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Anti-Bacterial Agents / administration & dosage*
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Anti-Bacterial Agents / therapeutic use
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Arthritis, Infectious / complications
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Arthritis, Infectious / diagnosis
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Arthritis, Infectious / drug therapy*
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Arthritis, Infectious / microbiology
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Bone and Bones
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C-Reactive Protein / analysis
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Child
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Child, Preschool
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Clindamycin / administration & dosage
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Clindamycin / therapeutic use
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Drug Administration Schedule
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Finland
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Humans
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Joints
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Kingella kingae / drug effects*
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Kingella kingae / growth & development
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Linezolid
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Methicillin Resistance / drug effects
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Methicillin-Resistant Staphylococcus aureus / drug effects*
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Methicillin-Resistant Staphylococcus aureus / growth & development
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Neisseriaceae Infections / complications
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Neisseriaceae Infections / diagnosis
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Neisseriaceae Infections / drug therapy*
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Neisseriaceae Infections / microbiology
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Osteomyelitis / complications
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Osteomyelitis / diagnosis
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Osteomyelitis / drug therapy*
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Osteomyelitis / microbiology
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Oxazolidinones / administration & dosage
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Oxazolidinones / therapeutic use
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Prospective Studies
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Randomized Controlled Trials as Topic
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Staphylococcal Infections / complications
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Staphylococcal Infections / diagnosis
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Staphylococcal Infections / drug therapy*
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Staphylococcal Infections / microbiology
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Vancomycin / administration & dosage
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Vancomycin / therapeutic use
Substances
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Acetamides
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Anti-Bacterial Agents
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Oxazolidinones
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Clindamycin
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Vancomycin
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C-Reactive Protein
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Linezolid