PubMed Central: Published on 2020 August

AHOM was defined as any bone infection with a period between symptoms onset and diagnosis < two weeks.

AHOM was defined complicated in the presence of sepsis, septic shock, arthritis, cellulitis, sub-periosteal or muscle abscess, deep vein thrombosis pathological fracture, septic emboli or hospitalization in the intensive care unit.

Acute haematogenous osteomyelitis (AHOM) is the most common musculoskeletal infection in children. In most cases, AHOM is the consequence of hematogenous diffusion of a bacterial pathogen, commonly occurring in children under five years of age and in males.

Other risk factors for AHOM include history of recent trauma, recent febrile episodes or upper respiratory tract infections, prematurity, congenital or acquired immunodeficiency, or sickle cell disease.

The aim of the study was to highlight the extent of the use and the possible role of amoxicillin-clavulanic acid in the oral treatment of children with AHOM.

Clinical, laboratory and therapeutic data from children with AHOM hospitalized in one Italian Paediatric Hospital between 2010 and 2019 were retrospectively collected and analyzed.

TAKE HOME MESSAGE:

Since microbiological diagnosis is obtained in about one-third of children, most cases undergo an empirical antibiotic therapy, based on individual clinical features, age, and local epidemiological data. In low/intermediate MRSA prevalence settings, antistaphylococcal penicillin (i.e., oxacillin or flucloxacillin), a cephalosporin, or clindamycin are the recommended first-line treatment.

Accumulating data support the use of short IV therapy followed by oral antibiotic therapy in uncomplicated cases.

According to the Guidelines of the European Society of Pediatric Infectious Diseases (ESPID), in low methicillin-resistant Staphylococcus aureus (MRSA) prevalence settings, short intravenous therapy is recommended in uncomplicated cases of acute haematogenous osteomyelitis (AHOM), followed by empirical oral therapy, preferentially with first/second-generation cephalosporin or dicloxacillin or flucloxacillin.

However, several practical issues may arise using some of the first-line antibiotics such as poor palatability or adherence problems.

Amoxicillin-clavulanic acid therapy would be more feasible in children.

The preferred IV antibiotic regimen was oxacillin plus third-generation cephalosporin, adopted in more than 60% of children, while amoxicillin-clavulanic acid was the most commonly used oral drug (60.1%; n = 107/178) and it was associated with clinical cure in all treated children. Overall, four children developed sequelae. One (0.9%) sequela occurred among the 107 children treated with amoxicillin-clavulanic acid.

Study data demonstrate the extensive use of amoxicillin-clavulanic acid (>60%). Probably physicians considered its good activity against methicillin-sensitive S. aureus (MSSA), pharmacokinetics/pharmacodynamics profile and the low severe event event rate.

In conclusion, in this study dataset amoxicillin-clavulanic acid was used in two-thirds of children and associated with clinical cure and no failure in all of them. This finding is confirmed in larger studies, and suggests that amoxicillin-clavulanic acid might by recommend for oral antibiotic therapy in children with AHOM.