Osteomyelitis / Septic Arthritis / Pyomyositis / Discitis
- Consult paediatric ID for all cases.
- Review antibiotic choice once microbiology results available.
- Consider IV to oral switch if afebrile at 48-72 hours for unifocal disease, with pain improvement, decreasing inflammatory markers and resolution of fever.
- For complex disease (i.e. multifocal site, significant bone destruction, significant immunosuppression, sepsis/shock), IV duration may be longer and should be discussed with Paediatric ID team.
Typical duration of therapy for respective indications:
Septic Arthritis: 2 weeks
Osteomyelitis: 3-4 weeks (may require 6 weeks or longer if complex infection)
Pyomyositis: 2-3 weeks
Discitis: 4-6 weeks
Full guidelines on the management of bone and joint infections in children can be accessed here
5 years or younger
Preferred
ceftriaxone 80mg/kg (Max 4g) iv OD (if over 1 month old)
If criteria for IV to oral switch fulfilled as above switch to:
cefalexin po see dosing table below
OR,
Child 1-11 months: 0.5ml/kg po TDS of 125mg/31mg/5mL suspension
Child 1-5 years:10mLs po TDS of 125mg/31mg/5mL suspension
If unable to switch to oral therapy ambulate with ceftriaxone 80mg/kg (Max 4g) iv OD
For MRSA positive patients: ADD vancomycin iv
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 |
Alternative
For penicillin allergy (non-severe)
ceftriaxone 80mg/kg (Max 4g) iv OD (if over 1 month old)
If criteria for IV to oral switch fulfilled as above switch to cefalexin po see dosing table below
For MRSA positive patients: ADD vancomycin iv
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), including MRSA positive patient
co-trimoxazole 27 mg/kg iv BD
If criteria for IV to oral switch fulfilled as above 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 |
Over 5 years
Preferred
flucloxacillin 50 mg/kg (max=2g) iv QDS
If criteria for IV to oral switch fulfilled as above switch to oral flucloxacillin 25mg/kg (max=1g) po QDS
If po flucloxacillin not tolerated (e.g. suspension unpalatable) alternatives would be:
cefalexin po see dosing table below
OR,
-
- Up to 11 years: 10mL po TDS of the 250mg/62mg/5mL suspension.
- 12 years or older: 625mg po TDS
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 |
Alternative
For penicillin allergy (non-severe)
ceftriaxone 80mg/kg (max=4g) iv OD
If criteria for IV to oral switch fulfilled as above switch to cefalexin po see dosing table below
For MRSA positive patients: switch to vancomycin iv or if susceptible clindamycin po or iv
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)
clindamycin 10mg/kg (max=1.2g) iv QDS
If criteria for IV to oral switch fulfilled as above switch to clindamycin 6mg/kg (max=450mg) po QDS
For MRSA positive patients: ADD vancomycin iv if not susceptible to clindamycin