Milcent K, Guitton C, Koné-Paut I
Service de pédiatrie générale, rhumatologie pédiatrique, centre de références des maladies auto-inflammatoires, CHU de Kremlin-Bicêtre, Assistance publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France.
Arch Pediatr. 2009 Jan;16(1):7-13. doi: 10.1016/j.arcped.2008.10.016. Epub 2008 Dec 6.
The outcome of acute osteomyelitis in children has been modified by the use of potent antibiotics. However, treatment management remains unclear. The aim of this study was to investigate the current management of acute osteomyelitis in children in France.
A questionnaire regarding the choice and the duration of antibiotics was sent to French pediatricians and pediatric orthopedists.
Ninety-four centers answered the questionnaire: 72 pediatricians and 22 pediatric orthopedists. The response rate was 51% and the median number of children hospitalized per year for osteomyelitis was 4 in each center. The radiologic procedures most often used for diagnosis were X-rays (99%) and bone scintigraphy (82%). Two intravenous antibiotics schemes were used by 80% of centers: either an association of 3rd-generation cephalosporin plus fosfomycin or an association of penicillin M and aminoglycoside, followed by oral penicillin M or pristinamycin. Intravenous therapy lasted 7 to 14 days in 72% of the centers. The total duration of antibiotic therapy was 6 weeks for 55% of centers. In 83% of cases, immobilization was prescribed. The decision for treatment withdrawal was based on clinical, biological or empirical findings for 59, 75 and 60% of departments, respectively.
In spite of controversies and lack of consensus, regarding both the diagnostic procedures and treatment management, 2 main antibiotic therapy schemes emerged from our survey. However, the treatment duration appeared more variable. Reaching a consensus for acute-osteomyelitis care in children remains a critical issue.
强效抗生素的使用改变了儿童急性骨髓炎的治疗结果。然而，治疗管理仍不明确。本研究的目的是调查法国儿童急性骨髓炎的当前治疗管理情况。
向法国儿科医生和儿科骨科医生发送了一份关于抗生素选择和使用时长的调查问卷。
94个中心回复了问卷，其中72名儿科医生和22名儿科骨科医生。回复率为51%，每个中心每年因骨髓炎住院儿童的中位数为4名。最常用于诊断的放射学检查方法是X线（99%）和骨闪烁显像（82%）。80%的中心使用两种静脉抗生素方案：第三代头孢菌素加磷霉素联合使用，或青霉素M与氨基糖苷类联合使用，随后口服青霉素M或利奈唑胺。72%的中心静脉治疗持续7至14天。55%的中心抗生素治疗总时长为6周。83%的病例中规定了固定制动。分别有59%、75%和60%的科室根据临床、生物学或经验性发现决定停止治疗。
尽管在诊断程序和治疗管理方面存在争议且缺乏共识，但我们的调查中出现了两种主要的抗生素治疗方案。然而，治疗时长似乎更具可变性。就儿童急性骨髓炎护理达成共识仍然是一个关键问题。
