Routine Practices

  • Therapeutic and diagnostic aspirate for microbiology is recommended before antibiotics if patient is clinically stable
  • Obtain blood cultures and CRP prior to starting antibiotics If fluid/abscess present at site of infection, drain and send for culture prior to antibiotics (if patient is clinically stable) MRI of affected area
  • Consult ID for spinal or hip osteomyelitis.
  • Recommend ID consult if not responding to treatment, delayed presentation, chronic or recurrent osteomyelitis, associated wound or abscess, unusual organism, foreign body (e.g., orthopedic hardware)


Alternative Therapy

When cefazolin is unavailable

For MRSA or Beta-Lactam Allergy About 25% of Staphylococcus aureus are resistant to clindamycin

Oral Step-Down Options

If proven sensitive MRSA, or allergy to cephalexin

Usual Duration of Therapy

  • Acute uncomplicated osteomyelitis duration is usually 4 weeks
  • Switch to oral antibiotics after 3-4 days if clinically improved (no fever, using limb, and CRP trending down)
  • If bacteremic, may switch to oral antibiotics after 4-7 days if improving and uncomplicated course

More Information

Le Saux. CPS Statement on Acute Osteoarticular Infections in Children, 2018 Available Here