Appropriate Antibiotic Duration in Pediatric Bone and Joint Infection: A Systematic Review Original Research

Abstract

Background: Optimal duration of antibiotic therapy for childhood bone and joint infection (BJI) remains controversial, despite recent literature in support of shorter courses and early oral switch. We have reviewed the literature to summarise current evidence for reduced duration of antibiotic therapy with particular attention to regional variation in pathogen type and treatment success.

Methods: Systematic review was undertaken over the period Jan 1980 - Dec 2022 for children aged up to 18 years.  Cohort studies, systematic reviews, randomised controlled trials, and prospective studies were analysed for data on treatment success rates and time of therapy.

Results: A total of 34 studies met inclusion criteria reporting treatment duration for 8337 cases of BJI. There were five prospective studies, 21 cohort studies, six randomised controlled trials, and three systematic reviews.

Conclusions: There is moderate evidence for shortened duration of therapy with early switch to oral antibiotics in select patients. Studies reporting good success for reduced therapy included healthy patients with uncomplicated disease. Regional disease variation and study protocol heterogeneity limits widespread adoption of short-course treatment. The experience of BJI is diverse. Although the majority of children respond well to treatment there is subset who demonstrate acute or chronically complicated disease. Further research is needed to define patient and disease factors that contribute to treatment failure.