Exclusively Oral Treatment for Osteoarticular Infections in Children. Is It Time?

Osteoarticular infections (OAI) in children are bacterial infections that affect the bones and/or joints, such as osteomyelitis, septic arthritis, and spondylodiscitis. The conventional treatment approach for OAI consists of a prolonged course of intravenous antibiotics followed by oral therapy. However, there is an ongoing debate regarding the optimal duration of intravenous treatment and the efficacy of oral treatment for OAI.

When establishing the antibiotic strategies, the microbiological diagnosis is a key point. Novel molecular based techniques (multiplex polymerase chain reaction panels) BioFire® Joint Infection Panel can enable early diagnosis and adjusted treatment decisions. There is current evidence of the changing epidemiology of OAI, with Kingella kingae emerging as a common causative agent in young children, while Staphylococcus aureus remains prevalent in other age groups. Kingella kingae infections tend to be milder and have certain differential characteristics.

The minimally invasive approach to OAI consisting of performing arthrocentesis and joint lavage has been shown to be effective and with fewer complications than other approaches such as arthrotomy or arthroscopy.

All this gives rise to considering the possibility of carrying out an exclusively oral treatment and outpatient follow-up in selected cases of children without risk factors. This article reviews the data that support this new approach that is imposed in various infections with the maximum of: “Oral treatment is the new IV”.

Keywords: Osteomyelitis, Oral, Arthrocentesis, Children, Osteoarticular Infections, Treatment, Septic arthritis

Abbreviations:

BCI: Blood Culture Identification

JI: Joint Infection

MRSA: Methicillin-resistant S. aureus

OAI: Osteoarticular Infections

OM: Osteomyelitis

SA: Septic Arthritis

SD: Spondylodiscitis

PSI: Pyogenic sacroiliitis