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Treatment of Acute Osteomyelitis Using Oral Antibiotics in the Pediatric Population
Jennifer Kargel, MD; Douglas M. Sammer, MD; Jonathan Cheng, MD
University of Texas Southwestern Medical Center, Dallas, TX

Introduction: In our institution, we have treated a substantial number of pediatric patients with acute osteomyelitis of the hand. While treatment may initially require IV antibiotic therapy or minimal surgical debridement, the bulk of therapy in these patients has relied on oral antibiotic use. We present a retrospective cohort study to evaluate the modalities for treating osteomyelitis in the pediatric population.

Materials and Methods: A retrospective chart review was performed of all pediatric patients treated for acute osteomyelitis of the hand over a 4-year period. We collected pre-treatment information including demographic data (age, gender, and hand dominance), mechanism of injury, anatomical site, imaging studies, and relevant laboratory values. Outcomes data included type and duration of antibiotic therapy, need for surgical debridement, time to normalization of radiographic imaging, and length of follow-up. Resolution of osteomyelitis was confirmed with radiographic evidence of improved ossification at previous sites of lucency, accompanied by resolution of infection on clinical and laboratory exam.

Results: Twenty-eight pediatric patients with osteomyelitis (median age 8 years, range 1-16) involving 29 sites on the hand were included in the study. Male:female ratio was 1.6:1, and the most commonly involved digit was the index finger. In cases where cultures were available (39%), the most commonly identified pathogens were MRSA (n=4), mixed flora (n=4), MSSA (n=2), and coagulase negative Staphylococcus (n=2). 19 of 28 patients (68%) were treated with antibiotics alone, with a mean total duration of treatment of 6.4 weeks (SD=1.6). All patients in this group were successfully treated with either oral (PO) only (n=18) or PO+IV (n=1) antibiotics. 9 of 28 patients were treated with antibiotics and surgery, with a mean total duration of treatment of 10.1 weeks (SD=6.0). This group included pre-operative and post-operative (4/9), and post-operative only (5/9) antibiotic treatment.

Conclusion: In a majority of pediatric patients with acute osteomyelitis of the hand, the infection can be treated adequately with oral antibiotics only without surgery. Careful surveillance and clinical experience is necessary to identify patients who fail antibiotic-only treatment or who require surgical debridement at the time of diagnosis.

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