Pediatric Hospital Medicine

258 Part XI • Musculoskeletal

TABLE 43.3 IV ANTIBIOTIC THERAPY IN AHO IV ANTIBIOTIC CHOICE

RATIONALE AND RECOMMENDATIONS • If local CA-MRSA prevalence < 10% with mild to moderate illness

Initial parenteral therapy: • Cefazolin • Nafcillin/oxacillin Oral therapy transition: high-dose cephalexin Clindamycin or vancomycin Daptomycin (if clindamycin or vancomycin use is contraindicated for a patient) Trimethoprim/sulfamethoxazole is not recommended

• If local CA-MRSA prevalence > 10-20% • Vancomycin for critical illness regard less of local CA-MRSA prevalence • Clindamycin preferred if identified pathogen is susceptible • Renal protection • Ease of transition to oral therapy

Ampicillin, a β -lactam/ β -lactamase inhibitor combination, or a cephalosporin

• Kingella kingae identified as causative pathogen

The Pediatric Infectious Disease Society (PIDS) and Infectious Diseases Society of America (IDSA) clinical practice guidelines for AHO in pediatrics do not recommend end-of-therapy imaging studies in uncomplicated cases. 3 Transition of care considerations 3 : • PIDS and IDSA clinical practice guidelines for AHO in pediatrics recommend a 3- to 4-week total course of antibiotic therapy. • Early transition from IV to oral antibiotic therapy can occur in uncomplicated cases of AHO if a patient has responded well to IV antibiotic therapy (approximately 5-7 days from antibiotic initia tion) and can tolerate oral therapy. AHO, acute hematogenous osteomyelitis; CA-MRSA, community-acquired methicillin-resistant Staphylococcus aureus ; IV, intravenous. Data from Woods CR, Bradley JS, Chatterjee A, et al. Clinical practice guideline by the pedi atric infectious diseases society and the infectious diseases society of America: 2021 guideline on diagnosis and management of acute hematogenous osteomyelitis in pediatrics. J Pediatric Infect Dis Soc . 2021;10(8):801-844.

Copyright © 2024 Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited. • In cases of complicated AHO, immunocompromised patients, and unusual pathogens or uncommon bacterial strains, a longer dura tion of antibiotic therapy may be required.