Warning

Review previous microbiology results: If resistant target organisms previously isolated (e.g. MRSA, ESBL, known resistance to empirical antibiotic choices), discuss antibiotic choice with Paediatric and/or Microbiology Consultant.

User guide: for further advice regarding antimicrobial prescribing good practice, oral switch, penicillin allergy, dosing, and safety considerations: HERE

Osteomyelitis / Septic arthritis

Take blood cultures AND consult orthopaedics for samples, ideally prior to antibiotics.

First line 0 - 5 years old

IV cefUROXime

Oral switch: co-amoxiclav

First line 6+ years OLD

IV flucloxacillin

Oral switch: flucloxacillin (capsules) or co-amoxiclav (liquid)

Haemophilus influenzae B (Hib) vaccination incomplete: IV/PO co-amoxiclav

Penicillin allergy All ages

IV co-trimoxazole

Oral switch: co-trimoxazole

TOTAL duration (IV + PO)
  • Unifocal disease:
    • "Simple" disease at a single site
    • IV to PO switch: afebrile, pain free >24 hours, CRP <20 or reduced by 2/3 highest value
    • Duration:
      • septic arthritis: 3 weeks
      • osteomyelitis: 4-6 weeks
      • liaise with Microbiology Consultant / Orthopaedics
  • Complex disease:
    • Includes multifocal, significant bone destruction, resistant or unusual pathogen, immunosuppression, sepsis or shock or associated with metal work
    • IV to PO switch: after 14 days
    • Duration:
      • may require 6+ weeks of treatment
      • liaise with Microbiology / Consultant Orthopaedics

Discitis

Take blood cultures AND consult spinal surgeons. Consider fine needle aspiration / biopsy to obtain samples for microbiological culture (standard +/- TB) and molecular testing (targeted PCRs +/- 16S PCR).

First line

Discuss with Microbiology Consultant/Paediatric Consultant

If required, empirical options are listed within the UK-PAS guidelines: HERE

Editorial Information

Last reviewed: 20/02/2024

Next review date: 20/02/2026

Author(s): Dr Jon van Aartsen (Consultant Microbiologist), Dr Jed Bamber (Consultant Paediatrician).

Version: v1.0

Approved By: AMT (20.02.2024) and ADTC (28.02.2024)

Reviewer name(s): Dr Jed Bamber (Consultant Paediatrician), AMS Team.