Antibiotic management of acute osteomyelitis and septic arthritis in children.

Optimal antibiotic management of children with acute bone and joint infections depends on early clinical diagnosis, careful search for the infecting organism, and institution of vigorous surgical therapy. Because antibiotic treatment must be initiated before confirmatory laboratory data are available, clues to the bacteriologic etiology must be sought. Knowledge of the patient's age, the clinical circumstances of the infection, and the associated physical findings may provide a presumptive bacteriologic diagnosis. Gram-staining of the surgical aspirate or tissue may provide immediate information about the nature of the pathogen. Definitive culture results and antibiotic sensitivities may be useful in modifying therapy, if necessary. It is advocated that antibiotics be given parenterally for the full course of therapy because of the seriousness of the infection and the importance of high blood and tissue levels. To determine a response to therapy, frequent careful physical examinations along with periodic roentgenograms and sedimentation rate determinations are indicated. Because long-term, high-dose antibiotic-therapy can produce side effects, it is essential that studies be done to monitor any potentially harmful effects on organ systems.