Evaluating Clinical Outcomes in Children With Acute Osteomyelitis Treated With Intravenous Versus Oral Antimicrobial Therapy

Introduction and aim: Osteomyelitis is an infection of the bone that typically requires hospitalization for diagnosis and initial treatment. For many years, it has been assumed that osteomyelitis must be treated with intravenous (IV) antibiotics for the full course of therapy. However, recent data have demonstrated the efficacy of oral (PO) antibiotics. In addition, studies comparing the efficacy of IV versus PO antibiotics in children with osteomyelitis have found that there was no increased incidence of treatment failure when patients were transitioned to PO antibiotics. The Infectious Diseases Society of America 2021 guideline on the management of acute hematogenous osteomyelitis recommends transitioning from IV to PO regimens when an acceptable PO antibiotic is available. This study aimed to evaluate the efficacy and use of IV versus PO antibiotic therapy for the treatment of osteomyelitis at a pediatric tertiary care center. Methods: This retrospective chart review evaluated patients under 18 years of age admitted from January 2019 to December 2021 with a diagnosis of acute osteomyelitis. Patients were grouped according to the route of antimicrobial administration prescribed at hospital discharge. Results: Fifty-one patients with osteomyelitis were included, with 19 and 32 patients in the PO and IV groups, respectively. There was no difference in the treatment failure rate between the two groups (IV=3 {9.4%} versus PO=2 {10.5%}; p=1.000). Patients in the IV group had higher rates of adverse drug events compared to the PO group (IV=9 {28.1%} versus PO=4 {21.1%}), with diarrhea and drug-induced neutropenia being the most common. Conclusion: Oral therapy for osteomyelitis may be associated with fewer adverse events than IV therapy, with no difference in treatment failure.