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Review ArticleREVIEWS AND CONTEMPORARY UPDATES

Acute Hematogenous Osteomyelitis in Children

Nimmy Thakolkaran and Avinash K. Shetty
Ochsner Journal June 2019, 19 (2) 116-122; DOI: https://doi.org/10.31486/toj.18.0138
Nimmy Thakolkaran
1Department of Family Medicine, Mount Sinai Hospital, Chicago, IL
MBBS
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Avinash K. Shetty
2Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC
MD
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  • For correspondence: ashetty@wakehealth.edu
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    Figure.

    Magnetic resonance imaging of right ankle shows distal fibular osteomyelitis with subperiosteal abscess.

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    Table 1.

    Microorganisms Causing Osteomyelitis With Specific Risk Factors

    Clinical Association/Risk FactorCommon Microorganism
    Sickle cell diseaseStaphylococcus aureus, Salmonella spp, Streptococcus pneumoniae
    TraumaPolymicrobial (gram-negative, gram-positive, and anaerobic bacteria)
    Chronic granulomatous diseaseSerratia spp, Nocardia spp, Burkholderia cepacia, Aspergillus spp
    Intravenous drug useStaphylococcus aureus, Pseudomonas aeruginosa, Candida spp
    Animal or human bitesPasteurella multocida, Eikenella corrodens
    Kitten exposure, HIV infectionBartonella henselae
    Exposure to farm animalsCoxiella burnetii
    DiabetesPolymicrobial (Staphylococcus aureus common, coagulase-negative Staphylococci, Streptococci, Enterobacteriaceae, and anaerobic bacteria)
    Puncture woundStaphylococcus aureus, Pseudomonas aeruginosa
    • HIV, human immunodeficiency virus.

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    Table 2.

    Specific Pathogens and Antibiotic Treatment of Acute Osteomyelitis in Children

    OrganismTreatmentAlternatives
    Methicillin-susceptible Staphylococcus aureusAntistaphylococcal penicillinsaCefazolin, clindamycin
    Methicillin-resistant Staphylococcus aureusClindamycin,b vancomycinLinezolid, daptomycin, trimethoprim-sulfamethoxazole
    Group A StreptococcusPenicillin G, ampicillin, amoxicillinClindamycinb
    Streptococcus pneumoniaeCeftriaxone,b clindamycinbVancomycin
    Penicillin Gb
    Ampicillin, amoxicillinb
    Kingella kingaeAmpicillin or ampicillin-sulbactam
    Cephalosporin
    Enteric gram-negative rodsCeftriaxoneCiprofloxacin
    Pseudomonas aeruginosaCeftazidime, ticarcillin-clavulanateCiprofloxacin
    Neisseria gonorrhoeaeCeftriaxonePenicillin Gb
    Salmonella sppCeftriaxoneAmpicillinb
    AnaerobesPenicillin, clindamycinMetronidazole, meropenem
    • ↵aOxacillin, nafcillin, cloxacillin, flucloxacillin, dicloxacillin.

    • ↵bFor susceptible strains.

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    Table 3.

    Oral Antibiotic Dosages for Treating Acute Hematogenous Osteomyelitis in Children5,37

    AntibioticDose, mg/kg/dayDoses/day
    Clindamycin30-403-4
    Cephalexin1004
    Dicloxacillin75-1004
    Amoxicillin1004
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Ochsner Journal: 19 (2)
Ochsner Journal
Vol. 19, Issue 2
Jun 2019
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Acute Hematogenous Osteomyelitis in Children
Nimmy Thakolkaran, Avinash K. Shetty
Ochsner Journal Jun 2019, 19 (2) 116-122; DOI: 10.31486/toj.18.0138

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Acute Hematogenous Osteomyelitis in Children
Nimmy Thakolkaran, Avinash K. Shetty
Ochsner Journal Jun 2019, 19 (2) 116-122; DOI: 10.31486/toj.18.0138
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  • Anti-bacterial agents
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  • osteomyelitis

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