BONE AND JOINT INFECTIONS IN CHILDREN - LENGTH OF THE TREATMENT

The optimal length of the antibiotic course of bone and joint infections is not precisely known since no controlled prospective study has ever been performed to compare different, lengths of treatment as well as parenteral and oral antibiotic administration. The biological data do not help : it has been demonstrated that the ESR takes a longer time to get back to normal values than CRP does but nobody can say which of them is the best criteria to settle the extinction of the infectious process. All the authors recommand an alternative parenteral/oral treatment for osteomyelitis and bacterial arthritis as well. The mean course of the parenteral treatment of osteomyelitis seems to be about 7-10 days. The mean total course seems to be between 4 and 6 weeks, never below 3 weeks. The criteria to stop the treatment are not very precise : favourable clinical and Xray outcome, ESR below 20 mm. The mean parenteral course of antibiotic treatment of bacterial arthritis is 5-10 days. The length of the total course depends upon the bacteria and the size of the involved joint : a short treatment (10-15 days) seems to be sufficient when the bacteria are Haemophilus influenzae, meningococcus, hemolytic streptococcus , and pneumococcus, if the joint involved is a small or medium one. A long treatment (3-6 weeks) is necessary when the causative bacteria are Staphylococcus aureus, enterobactericae or anusual microbes, as well as in immunocompromized children whatever the agent may be. This treatment is mandatory when the joint involved is the hip or the shoulder. The severity of the osteoarthritis of the hip is to be stressed. A long course of the antibiotic treatment parenteral and oral as well is indicated for children with sickle-cell disease, for non hematogenous osteitis, disco-spondylitis, and sacro-ileitis. It is not necessary to increase the length of the antibiotic course in osteomyelitis of the pelvic bone. Chronic osteomyelitis needs for a prolonged oral treatment. The treatment of subacute osteomyelitis in not well fixed.