Management of childhood haematogenous osteomyelitis in a rural Papua New Guinean hospital.

Haematogenous osteomyelitis, especially in its more common chronic stage, is an important cause of morbidity in children in the Southern Highlands Province. Hospital stays are lengthy and the incidence of fractures is high. While awaiting, or in the absence of, culture and sensitivity results, cloxacillin 200 mg/kg/day plus probenecid 40 mg/kg/day is an appropriate first choice antibiotic when it is available. Antibiotic therapy in chronic disease should be limited to the specific settings of associated soft tissue infection; pre- and post-sequestrectomy; and radiological signs of ongoing bone necrosis and systemic signs of active infection. Surgical drainage of subperiosteal pus and possibly the medullary canal is required in all but the very early (less than 48 hours) cases of acute osteomyelitis that sometimes respond to antibiotics alone. Sequestrectomy should be reserved for cases where a sequestrum and adequate involucrum can be seen on X-ray. Effective management of this disease is possible only if ongoing communication exists between hospital-based medical staff and the staff of health centres or subcentres, including the network of aid post orderlies and their supervisors. Since the majority of patients present to facilities other than hospitals, any campaign directed at improving management must involve co-workers in rural areas, namely the health extension officer, nurse and aid post orderly. Only in this way can we hope to achieve earlier appropriate treatment and more systematic long-term follow-up.