How to choose the duration of therapy for osteomyelitis in adults and children

The duration of therapy required to treat osteomyelitis, including the minimum duration of intravenous therapy, differs between adults and children – see Duration of therapy for osteomyelitis in adults and Duration of therapy for osteomyelitis in children.

For patients who are stable, evidence supports an earlier switch to oral therapy, as well as a shorter total duration of therapy (intravenous + oral), than previously recommended¹ – these shorter durations are reflected in Suggested duration of antibiotic therapy for osteomyelitis in adults for adults and Suggested duration of antibiotic therapy for osteomyelitis in neonates and children for children. Expert advice should guide when to switch to oral therapy and the choice of regimen, and multidisciplinary specialist discussion may be necessary. Factors to consider includeLi 2019McMullan 2016:

• the presence of prosthetic material – seek expert advice
• the presence of a concomitant infection that requires a longer course of intravenous therapy (eg Staphylococcus aureus bacteraemia, infective endocarditis, spinal epidural abscess). Refer also to Suggested duration of antibiotic therapy for osteomyelitis in adults
• the patient’s suitability for oral therapy, including being
  • clinically stable
  • able to tolerate oral intake with no concerns about malabsorption
  • likely to adhere to oral therapy
• the availability of an oral antimicrobial that meets the following criteria
  • treats the identified or expected organism
  • has good bioavailability and is able to be given at a high enough dose to achieve adequate exposure at the target site for the relevant organism – see Oral and enteral route of administration for antimicrobials
  • is palatable and available in a suitable formulation (eg a paediatric formulation for children).