Acute osteoarticular infection, including septic arthritis and acute osteomyelitis
- Consult paediatric ID for all cases.
- Review antibiotic choice once microbiology results available.
- Initial oral therapy should be considered for all patients unless complex or features of high risk disease (see below).
- A review should be undertaken at 48-72 hours to ensure pain improvement, decreasing inflammatory markers and resolution of fever. IV to oral switch should be considered at that stage, if patient not already on oral antibiotics.
- For complex or high risk disease (i.e. multifocal site, significant bone destruction, significant immunosuppression, significant soft tissue infection, sepsis/shock or less than 3 months of age), initial antibiotics should be administered IV, often for a longer duration (i.e. Up to 2 weeks)
Typical duration of therapy for respective indications:
Septic Arthritis: 10-14 days
Osteomyelitis: 3-4 weeks (may require up to 6 weeks if complex infection)
Pyomyositis: 2-3 weeks
Discitis: 4 weeks
Preferred including penicillin (non-severe) allergy
cefalexin po see dosing table below
If high risk/complex disease or unable to tolerate orals: cefazolin 50mg/kg (Max 2g) iv TDS
- Oral switch at 48-72 hours if clinical and biochemical improvement: Switch to cefalexin po tds (see dosing table below)
- If unable to switch to oral therapy: Ambulate with ceftriaxone 80mg/kg (Max 4g) iv OD (if over 1 month old)
cefalexin oral dosing table:
|
Weight |
cefalexin oral dosing |
|
Less than 15 kg |
33 mg/kg po TDS |
|
15 to 20 kg |
500mg po TDS |
|
21 to 30 kg |
750mg po TDS |
|
31 to 40 kg |
1g po TDS |
|
Over 40 kg |
1g po QDS |
For penicillin allergy (severe) or MRSA patients
co-trimoxazole 27 mg/kg (Max 1.44g) iv BD
Oral switch at 48-72 hours if clinical and biochemical improvement: Switch to oral co-trimoxazole (see dosing table below) if susceptibilities allow:
|
Age |
co-trimoxazole oral dose |
|
6 Weeks to 5 years |
24mg/kg BD |
|
6 Years to 11 years |
24mg/kg (max 960mg) BD |
|
12 years to 17 years |
960mg BD |