BACKGROUND: The emergence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) has complicated the conventional management of osteomyelitis. While oral clindamycin is commonly used to treat acute CA-MRSA osteomyelitis, the emergence of inducible clindamycin resistance among CA-MRSA isolates has made alternative therapy necessary. The excellent oral bioavailability, susceptibility profile, favorable palatability, and low cost of trimethoprim-sulfamethoxazole (TMP-SMX) make this drug an attractive option for treating osteomyelitis, yet its clinical efficacy for osteomyelitis has not been established. METHODS: Between October 1998 and September 2009, 20 children who received a TMP-SMX-containing regimen for acute osteomyelitis at All Children's Hospital were identified from hospital records, and their cases reviewed for clinical outcome and drug safety. RESULTS: Patients ranged in age from 9 months to 17 years. Twelve (60%) of the patients were male. Causative pathogens were found in 8 (40%) cases of which 5 were CA-MRSA and 3 were methicillin-susceptible Staphylococcus aureus. Eleven patients (55%) received TMP-SMX as their primary therapy. The median dose of TMP-SMX was 16.4 mg/kg/d. During TMP-SMX therapy, 8 patients (40%) experienced adverse events; all were considered mild. Duration of total therapy was 26 to 59 days, with a median of 40 days. All 20 patients were considered cured of their infection at the end of therapy. CONCLUSION: Orally administered TMP-SMX appears to be a useful and well-tolerated therapy for treatment of acute osteomyelitis in children. Further prospective comparative studies will be needed to confirm this observation.
BACKGROUND: The emergence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) has complicated the conventional management of osteomyelitis. While oral clindamycin is commonly used to treat acute CA-MRSA osteomyelitis, the emergence of inducible clindamycin resistance among CA-MRSA isolates has made alternative therapy necessary. The excellent oral bioavailability, susceptibility profile, favorable palatability, and low cost of trimethoprim-sulfamethoxazole (TMP-SMX) make this drug an attractive option for treating osteomyelitis, yet its clinical efficacy for osteomyelitis has not been established. METHODS: Between October 1998 and September 2009, 20 children who received a TMP-SMX-containing regimen for acute osteomyelitis at All Children's Hospital were identified from hospital records, and their cases reviewed for clinical outcome and drug safety. RESULTS:Patients ranged in age from 9 months to 17 years. Twelve (60%) of the patients were male. Causative pathogens were found in 8 (40%) cases of which 5 were CA-MRSA and 3 were methicillin-susceptible Staphylococcus aureus. Eleven patients (55%) received TMP-SMX as their primary therapy. The median dose of TMP-SMX was 16.4 mg/kg/d. During TMP-SMX therapy, 8 patients (40%) experienced adverse events; all were considered mild. Duration of total therapy was 26 to 59 days, with a median of 40 days. All 20 patients were considered cured of their infection at the end of therapy. CONCLUSION: Orally administered TMP-SMX appears to be a useful and well-tolerated therapy for treatment of acute osteomyelitis in children. Further prospective comparative studies will be needed to confirm this observation.
Authors: V Prendki; T Ferry; P Sergent; E Oziol; E Forestier; T Fraisse; S Tounes; S Ansart; J Gaillat; S Bayle; O Ruyer; F Borlot; G Le Falher; B Simorre; F-A Dauchy; S Greffe; T Bauer; E N Bell; B Martha; M Martinot; M Froidure; M Buisson; A Waldner; X Lemaire; A Bosseray; M Maillet; V Charvet; A Barrelet; B Wyplosz; M Noaillon; E Denes; E Beretti; M Berlioz-Thibal; V Meyssonnier; E Fourniols; L Tliba; A Eden; M Jean; C Arvieux; K Guignery-Kadri; C Ronde-Oustau; Y Hansmann; A Belkacem; F Bouchand; G Gavazzi; F Herrmann; J Stirnemann; A Dinh Journal: Eur J Clin Microbiol Infect Dis Date: 2017-04-04 Impact factor: 3.267
Authors: Julia Natterer; Frida Rizzati; Marie-Hélène Perez; David Longchamp; Vivianne Amiet; Quentin DeHalleux; Kim Dao; Thomas Ferry Journal: J Pediatr Intensive Care Date: 2020-07-30
Authors: Laurene Deconinck; Aurélien Dinh; Christophe Nich; Thomas Tritz; Morgan Matt; Olivia Senard; Simon Bessis; Thomas Bauer; Martin Rottman; Jérome Salomon; Frédérique Bouchand; Benjamin Davido Journal: PLoS One Date: 2019-10-17 Impact factor: 3.240