Weichert Stefan, Sharland Mike, Clarke Nicholas M P, Faust Saul N
Paediatric Infectious Diseases Unit, St George's Hospital, London, UK.
Curr Opin Infect Dis. 2008 Jun;21(3):258-62. doi: 10.1097/QCO.0b013e3283005441.
Despite diagnostic and therapeutic advances, acute haematogenous osteomyelitis in children continues to cause significant morbidity and disease burden. The molecular epidemiology of causal organisms has wide geographic variation, but regardless of cause children often require several weeks of inpatient parenteral antibiotic therapy. This review focuses on antibiotic treatment and length of antibiotic therapy.
Currently there is no international and little local consensus regarding the route or duration for antibiotic treatment of acute haematogenous osteomyelitis in children. Although there are encouraging data from review papers and case series, no randomized controlled trial has been conducted to show good evidence for shorter courses of parenteral antibiotic treatment. Prospective studies show effective treatment for a wide variety of antibiotic agents, but there are few comparative studies. Overall treatment for 4-6 weeks is considered standard therapy, but the laboratory or clinical parameters that would determine the decision to switch to oral therapy remain undefined.
Evidence-based data about the route and duration of intravenous antibiotic treatment for acute haematogenous osteomyelitis in children are still limited to observational and retrospective studies. A randomized controlled trial will provide much needed data.
尽管在诊断和治疗方面取得了进展，但儿童急性血源性骨髓炎仍会导致严重的发病率和疾病负担。致病微生物的分子流行病学在地域上存在很大差异，但无论病因如何，儿童通常需要数周的住院静脉抗生素治疗。本综述重点关注抗生素治疗及抗生素治疗时长。
目前，对于儿童急性血源性骨髓炎抗生素治疗的途径或疗程，国际上尚无共识，国内也鲜少有一致意见。尽管综述文章和病例系列中有一些令人鼓舞的数据，但尚未进行随机对照试验来证明较短疗程的静脉抗生素治疗有充分依据。前瞻性研究表明多种抗生素治疗有效，但比较研究较少。总体而言，4至6周的治疗被视为标准疗法，但决定转为口服治疗的实验室或临床参数仍不明确。
关于儿童急性血源性骨髓炎静脉抗生素治疗的途径和疗程，基于证据的数据仍仅限于观察性和回顾性研究。一项随机对照试验将提供急需的数据。
