Etiology and medical management of acute suppurative bone and joint infections in pediatric patients

A successful outcome to suppurative arthritis and acute osteomyelitis in infancy and childhood depends largely on early recognition of the exact etiologic process and initiation of appropriate therapy. Delay in diagnosis and treatment increases the chances of significant morbidity and permanent disability. The purposes of this review are to discuss the likely clinical setting in which the diagnosis of acute osteomyelitis or suppurative arthritis should be suspected, to outline a stepwise approach to aid the clinician in establishing the diagnosis, to review appropriate antibiotic management based on microbial etiologies, to present guidelines for oral antibiotic therapy and to provide recommendations for monitoring the patient's therapeutic response. Surgical aspects of management are not discussed in detail.