Duration of therapy for osteomyelitis in children

Children with osteomyelitis usually require a shorter duration of antibiotic therapy than adults. The minimum duration of therapy (intravenous + oral) is outlined in Suggested duration of antibiotic therapy for osteomyelitis in neonates and children.

In children with acute osteomyelitis, intravenous therapy should generally be continued until the child is afebrile and has clinically improved. Some children may need a longer duration of intravenous therapy than recommended in Suggested duration of antibiotic therapy for osteomyelitis in neonates and children – seek expert advice. For additional details on the route and duration of therapy (including timing of switch to oral therapy), see the guidelines produced by the Australian and New Zealand Paediatric Infectious Diseases–Australasian Stewardship of Antimicrobials in Paediatrics groupMcMullan 2016.

In children who are stable but require prolonged intravenous therapy, ambulatory antimicrobial therapy may be appropriate.

Table 1. Suggested duration of antibiotic therapy for osteomyelitis in neonates and children[NB1]

Patient age

Suggested duration of antibiotic therapy [NB2]

Intravenous

Total (intravenous + oral)

Acute uncomplicated osteomyelitis [NB3]

neonate [NB4]

nonvertebral: 4 weeks

vertebral: 6 weeks

child

2 days or until the child is afebrile and has clinically improved

nonvertebral: 2 to 3 weeks

vertebral: 6 weeks

Acute complicated osteomyelitis [NB3]

neonate [NB4]

nonvertebral: 4 weeks

vertebral: 6 weeks

child

at least 4 days [NB5]

nonvertebral: at least 3 weeks [NB5]

vertebral: 6 weeks

Chronic osteomyelitis

child

may not be necessary

at least 6 weeks

Note:

NB1: Factors that influence the duration of therapy and timing of intravenous to oral switch are discussed in How to choose the duration of therapy for osteomyelitis in adults and children and expanded on in Duration of therapy for osteomyelitis in children.

NB2: The suggested durations of therapy recommended for osteomyelitis in this table are a guide only – shorter or longer durations of therapy may be considered in some circumstances. Seek expert advice.

NB3: Complicated osteomyelitis in children includes infection that is associated with a wound or abscess, or for which presentation was delayed. Infection is otherwise considered uncomplicated.

NB4: Intravenous antibiotics are used for the total duration of therapy.

NB5: Both a longer duration of initial intravenous therapy and a longer total duration of therapy (intravenous + oral) are likely to be required – seek expert advice.