Antibiotics in the blood enter bone at levels equal to those in the serum, except for dead bone. The usual clinical presentation is the sudden onset of deep, poorly localized metaphyseal pain in a child who shows few signs of systemic illness. All ages are susceptible to osteomyelitis but the majority of cases occur between the ages of three to twelve. The usual regimen of antibiotic use for osteomyelitis calls for parenteral administration for five to seven days. If there is a significant clinical response, oral antibiotics are started and adequacy of serum concentration is determined.
Treatment is continued for at least four weeks.
If clinical evolution is slow and the sedimentation rate is still elevated, antibiotics should be continued until these parameters are normal. Complications may result from inadequate treatment. These include chronic osteomyelitis, growth disturbance, septic arthritis, and pathologic fracture. Summary Infection involving bones and joints is relatively common in children and can result in a serious, permanent disability. It is imperative to be suspicious of this entity in any child with sudden onset of localized metaphyseal or joint pain and loss of function in that region, especially in the presence of mild or severe systemic symptoms.