Farmacoriflessioni
Trattamento antibiotico di osteomielite, artrite settica e piomiosite
ANTIBIOTIC TREATMENT FOR OSTEOMYELITIS, SEPTIC ARTHRITIS AND PYOMYOSITIS
Federico Marchetti1, Elisa Rizzello1, Federico Poropat1, Francesca Rovere2, Claudio Germani3, Gianni Messi3, Sergio Demarini4, Marco Carbone5, Stefano Furlan6, Paolo Tamaro7, Marina Busetti8, Alessandro Ventura1
1Clinica Pediatrica, Dipartimento di Pediatria
2SC Farmacia e Nutrizione Parenterale
3SCO Pediatria d’urgenza con servizio di Pronto Soccorso
4SCO Neonatologia e Terapia Intensiva Neonatale
5SCO Ortopedia e Traumatologia
6SCO Anestesia e Rianimazione
7SCO Oncoematologia
8Servizio di Microbiologia e Medicina Preventiva, IRCCS “Burlo Garofolo”, Trieste
Novembre 2010 - pagg. 585 -589
Abstract
Evidence for the choice or duration of antibiotic treatment for bone, joint infections and
pyomyositis is scarce and no randomised trials (RCT) have been done in children and
adolescents. The recommendations contained in this work come from the audit on the
management of children with osteomyelitis, septic arthritis and pyomyositis hospitalized
at the Institute for Child Health “Burlo Garofolo”, Trieste, Italy in the last 8 years. The antibiotic
regimen should be based on likelihood of the organisms involved and current local
sensitivity patterns, modified subsequently by results of Gram stain and culture. Because
probable pathogen in all risk groups is Staphylococcus aureus, initial antibiotic
treatment should have bactericidal activity against this bacterium. Suitable choices include
β-lactamase-stable penicillins (such as oxacillin and similar) for the treatment of
bone and joint infections (with the exception of newborns). For the cases of pyomyositis,
findings of studies have consistently showed a worrying increase in meticillin-resistant
Staphylococcus aureus infection and the choice of vancomicin or clindamycin seems to
be reasonable. As to the duration of the treatment, 4 RCT on paediatric patients reported
that the shorter courses of parenteral antibiotic therapy do not appear to influence
response rates for children with acute hematogenous osteomyelitis.
Parole chiave
Suggerite dall'AI
Classificazione MeSH
Bibliografia
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Corrispondenza: marchetti@burlo.trieste.it