Antibiotic therapy for osteoarticular infections in 2023: Proposals from the Pediatric Infectious Pathology Group (GPIP)

• Published in: Infectious diseases now (Online) Vol. 53; no. 8; p. 104789
• Main Authors: Lorrot, Mathie, Gillet, Yves, Basmaci, Romain, Bréhin, Camille, Dommergues, Marie-Aliette, Favier, Marion, Jeziorski, Eric, Panetta, Luc, Pinquier, Didier, Ouziel, Antoine, Grimprel, Emmanuel, Cohen, Robert
• Format: Journal Article
• Language: English
• Published: Elsevier Masson SAS 01.11.2023; Elsevier
• Subjects: Antibiotic therapy; children; Human health and pathology; Immunology; Infectious diseases; Life Sciences; osteoarticular infections; children; osteoarticular infections; Antibiotic therapy
• DOI: 10.1016/j.idnow.2023.104789
• ISSN: 2666-9919

•Most osteoarticular infections (OAI) occur via the hematogenous route, and most frequently affect children under 5 years of age.•Early diagnosis and prompt treatment are needed to avoid complications.•Staphylococcus aureus is implicated in OAIs in children at all ages and Kingella kingae is a very common causative pathogen in those from 6 months to 4 years old.•Given its effective activity against K. kingae and methicillin-susceptible S. aureus (predominant in France) the initial treatment is cefazolin by IV route.•In most children presenting uncomplicated BJI with favorable outcome (disappearance of fever and pain), short intravenous antibiotic therapy for 3 days can be followed by oral therapy. Minimum total duration of antibiotic therapy should be 14 days for septic arthritis, and 3 weeks for osteomyelitis. Most osteoarticular infections (OAI) occur via the hematogenous route, affect children under 5 years of age old, and include osteomyelitis, septic arthritis, osteoarthritis and spondylodiscitis. Early diagnosis and prompt treatment are needed to avoid complications. Children with suspected OAI should be hospitalized at the start of therapy. Surgical drainage is indicated in patients with septic arthritis or periosteal abscess. Staphylococcus aureus is implicated in OAI in children at all ages; Kingella kingae is a very common causative pathogen in children from 6 months to 4 years old. The French Pediatric Infectious Disease Group recommends empirical antibiotic therapy with appropriate coverage against methicillin-sensitive S. aureus (MSSA) with high doses (150 mg/kg/d) of intravenous cefazolin. In most children presenting uncomplicated BJI with favorable outcome (disappearance of fever and pain), short intravenous antibiotic therapy during 3 days can be followed by oral therapy. In the absence of bacteriological identification, oral relay is carried out with the amoxicillin/clavulanate combination (80 mg/kg/d of amoxicillin) or cefalexin (150 mg/kg/d). If the bacterial species is identified, antibiotic therapy will be adapted to antibiotic susceptibility. The minimum total duration of antibiotic therapy should be 14 days for septic arthritis, 3 weeks for osteomyelitis and 4-6 weeks for OAIs of the pelvis, spondylodiscitis and more severe OAIs, and those evolving slowly under treatment or with an underlying medical condition (neonate, infant under 3 months of old, immunocompromised patients). Treatment of spondylodiscitis and severe OAI requires systematic orthopedic advice.