Short-course Intravenous Antibiotic Therapy of Pediatric Acute Bone and Joint Infections: A Systematic Review and Meta-analysis

BACKGROUND: Pediatric bone and joint infections (BJIs) are traditionally treated with prolonged intravenous antibiotics, although the optimal duration remains uncertain. Recent studies support shorter intravenous courses and, in some cases, oral therapy alone. However, the minimum effective intravenous duration remains undefined. OBJECTIVES: To evaluate the effectiveness of abbreviated intravenous regimens in previously healthy children with acute BJIs. METHODS: MEDLINE, CENTRAL and Scopus were searched up to December 31, 2024, for studies including children >3 months old with uncomplicated BJIs treated with ≤5 days of intravenous antibiotics. Studies with comorbidities, prosthetic joints or surgical-site infections were excluded. Risk of bias was assessed using RoB-2 and ROBINS-I, and certainty of evidence with GRADE. This systematic review was registered in PROSPERO (CRD42024614740). RESULTS: Of 6 studies (813 children) included in the qualitative synthesis, 3 were eligible for meta-analysis. The pooled odds ratio for treatment success with short-course intravenous therapy (≤5 days) or oral-only treatment compared with longer intravenous regimens was 1.65 (95% confidence interval: 0.46-5.98), showing no significant difference between groups. Statistical heterogeneity was low (I2 = 0%). Sensitivity analyses confirmed the direction and stability of findings. The certainty of evidence for treatment success was rated low due to imprecision and limited estimable studies. CONCLUSIONS: This systematic review and meta-analysis suggest that short-course intravenous therapy-or even exclusive oral antibiotic treatment-may be as effective as longer intravenous regimens for uncomplicated pediatric BJIs in healthy children. However, given the low certainty of evidence, these strategies should be applied cautiously and guided by clinical judgment. Further high-quality trials are needed to confirm these findings.