Empirical therapy for osteomyelitis in children
For empirical therapy for children younger than 4 years with long-bone or vertebral osteomyelitis who do not have sepsis or septic shock, use:
1cefazolin 50 mg/kg up to 2 g intravenously, 8-hourly. See advice on intravenous to oral switch and duration of therapy cefazolin
OR
2flucloxacillin 50 mg/kg up to 2 g intravenously, 6-hourly. See advice on intravenous to oral switch and duration of therapy. flucloxacillin
For empirical therapy for children 4 years or older with long-bone or vertebral osteomyelitis who do not have sepsis or septic shock, use:
1cefazolin 50 mg/kg up to 2 g intravenously, 8-hourly. See advice on intravenous to oral switch and duration of therapy cefazolin
OR
1flucloxacillin 50 mg/kg up to 2 g intravenously, 6-hourly. See advice on intravenous to oral switch and duration of therapy. flucloxacillin
For children at increased risk of methicillin-resistant Staphylococcus aureus (MRSA) infection, add vancomycin to either of the regimens above. Add:
vancomycin intravenously; for initial dosing, see Intermittent vancomycin dosing for young infants and children. See advice on intravenous to oral switch and duration of therapy. vancomycin
In some regions, based on local susceptibility data, clindamycin is a suitable alternative to vancomycin. Consider:
clindamycin 15 mg/kg up to 600 mg intravenously, 8-hourly1. See advice on intravenous to oral switch and duration of therapy. clindamycin
For children who have had a nonsevere (immediate or delayed) hypersensitivity reaction to a penicillin, use cefazolin (see dosage above).
For children who have had a severe immediate2 hypersensitivity reaction to a penicillin, cefazolin (at the dosage above) can be considered if a beta-lactam antibiotic is strongly preferred (for considerations, see Severe immediate hypersensitivity: Implications of cross-reactivity between penicillins and cephalosporins).
For children who have had a severe immediate2 hypersensitivity reaction to a penicillin in whom cefazolin is not used, or for children who have had a severe delayed3 hypersensitivity reaction to a penicillin, use vancomycin (see dosage above) or seek expert advice if K. kingae infection is suspected.