ANTIBIOTICS USE IN OSTEOMYELITIS IN CHILDREN : REVIEW ARTICLE

Osteomyelitis is an infection of bone sustained most commonly by bacteria, although fungal etiology is rarely described, particularly in immune-compromised children . When adult are affected is usually because their resistance is lowered . The causal organism in both adult and children usually Staphylococcus . Antistaphylococcal penicillin such as oxacillinor flucoxacillin and/or a cephalosporin are recommended as first line treatment. Rajiv Jaiswal et al., IJSIT, 2017, 6(1), 001-008 IJSIT (www.ijsit.com), Volume 6, Issue 1, January-February 2017 2 INTRODUCTION Osteomyelitis is an infection of bone sustained most commonly by bacteria, although fungal etiology is rarely described, particularly in immune-compromised children [1]. According to the time period between diagnosis and symptom onset, osteomyelitis is classified as acute (<2 weeks), sub-acute (2 weeks–3 months), or chronic (>3 months). Bacteria may reach bone marrow through the bloodstream, or spreading from nearby tissue. Infection can also be subsequent to an injury that exposes bone to a contaminated environment [1]. The estimated incidence of acute osteomyelitis is about 8 cases per 100,000 children/year [2,3] Children under 5 years of age are affected in about 50% of the cases, with a M:F ratio of 2:1. Acute osteomyelitis is approximately two times more frequent than septic arthritis, and its incidence is steadily increasing. Gafur et al. [4] observed that the incidence of acute osteomyelitis has tripled over the last 20 years while the incidence of septic arthritis remained constant. Early detection is crucial given that a delay in the diagnosis of only 4 days is a risk factor for long-term sequelae . Possible complications include septic arthritis, subperiosteal abscess, pyomyositis, deep vein thrombosis, sepsis, and multiorgan failure. Even if the mortality is less than 1%, permanent disabilities can occur, such as growth arrest with limb length discrepancy. Moreover, acute osteomyelitis can evolve to the chronic form. Most of pediatric osteomyelitis originates as a bloodstream infection. The route of entry may be the respiratory tract, particularly for K. kingae, S. pyogenes and S. pneumoniae, while the skin may be a common port of entry for S. aureus [3]. Less frequently, acute osteomyelitis spreads from contiguous tissues or from direct inoculation following trauma or surgery. Its clinical presentation and imaging can be highly variable, and culture can be negative in 34 to 60% of histologically proven osteomyelitis cases. [11] Delayed treatment can result in overwhelming sepsis, chronic infection, bony deformity, and/or growth retardation. [5,7,10–13] Complications generally arise within one year of discharge and the rate ranges from 10 to 25%; risk factors for complications include infection with Staphylococcus aureus, disease in infancy, and a 4-to5-day delay from symptom onset to treatment. [8,11,14] Optimal treatment for pediatric osteomyelitis remains controversial. [5–9,15–17] Surgical treatment to reduce the bacterial load is increasingly popular owing to the rising incidence of methicillinresistant S. aureus. [6,18] Drainage enables collection of a larger sample for culture to guide antibiotic therapy. [11] Traditionally, surgery is indicated when there is concurrent septic arthritis, failure of clinical improvement after 48 to 72 hours of antibiotic treatment, and/or radiological evidence of a pelvic abscess >2 cm. [5,6,9,19] Although many children recover quickly with medical treatment alone,[5,16] surgery is still performed in up to 50% of patients. [6,9,12]