Simplified treatment of acute staphylococcal osteomyelitis of childhood. The Finnish Study Group

Pediatrics. 1997 Jun;99(6):846-50. doi: 10.1542/peds.99.6.846.


Objective: Recommendations on treatment of acute staphylococcal osteomyelitis of children, based mostly on retrospective analyses, comprise surgical drainage, up to 6 weeks fo antimicrobials guided by the erythrocyte sedimentation rate, and the possibility of switching to the oral route only if monitoring of serum bactericidal titer is guaranteed. A prospective study was conducted to test whether the treatment could be simplified.

Design: Fifty pediatric cases of acute Staphylococcus aureus osteomyelitis were randomized to receive 150 mg/kg/day of cephradine divided in four doses, or 40 mg/kg/day in four doses of clindamycin. The treatment was initiated intravenously, but switched to oral administration mostly within 4 days, using the same doses. The peak antimicrobial serum inhibitory titer or bactericidal titer was not measured. The course of illness was monitored by blood leukocytes, erythrocyte sedimentation rate, and serum C-reactive protein. The follow-up was extended to 1 year posthospitalization.

Setting: Eight tertiary pediatric-orthopedic hospitals in Finland.

Main outcome measure: Full recovery and remaining healthy at least 12 months from hospital discharge.

Results: The lower and upper extremities were affected in 72% and 8% of patients, respectively. No surgery at all or needle aspiration only was performed in 62% and drilling in 38%. C-reactive protein and the sedimentation rate normalized within 9 days and 29 days, respectively. X-ray changes developed in 68% but had no prognostic significance. The mean hospitalization time was 11 days, and the total duration of antimicrobials was 23 days. No failure has occurred nor have long-term sequelae been observed in any patient.

Conclusions: Treatment of pediatric acute staphylococcal osteomyelitis can be simplified and costs reduced by keeping surgery at a minimum, shortening hospitalization and the course of antimicrobials, switching quickly to the oral route, and not monitoring serum bactericidal activity.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial

MeSH terms

  • Acute Disease
  • Adolescent
  • Anti-Bacterial Agents / administration & dosage
  • Anti-Bacterial Agents / therapeutic use*
  • Cephradine / administration & dosage
  • Cephradine / therapeutic use*
  • Child
  • Child, Preschool
  • Clindamycin / administration & dosage
  • Clindamycin / therapeutic use*
  • Drug Administration Routes
  • Drug Administration Schedule
  • Female
  • Follow-Up Studies
  • Humans
  • Infant
  • Length of Stay
  • Male
  • Osteomyelitis / blood
  • Osteomyelitis / drug therapy*
  • Osteomyelitis / therapy
  • Prospective Studies
  • Serum Bactericidal Test
  • Staphylococcal Infections / blood
  • Staphylococcal Infections / drug therapy*
  • Staphylococcal Infections / therapy


  • Anti-Bacterial Agents
  • Clindamycin
  • Cephradine