Narrative review of acute hematogenous osteomyelitis (AHO) in children, covering epidemiology, microbiology, imaging workup, culture techniques, and antibiotic management strategies. The central question is how to accurately diagnose and optimally treat pediatric AHO given variable culture yields, evolving imaging tools, and emerging antibiotic resistance.
When a child presents with fever, point tenderness over a long bone metaphysis, and elevated CRP, start empiric anti-staphylococcal IV antibiotics after obtaining blood and local bone cultures, then transition to high-dose oral therapy once the CRP trends down — you don't need weeks of IV therapy.
If the child fails to improve within 48 hours or aspiration yields pus, that's your trigger for surgical debridement.
Narrative review of acute hematogenous osteomyelitis (AHO) in children, covering epidemiology, microbiology, imaging workup, culture techniques, and antibiotic management strategies. The central question is how to accurately diagnose and optimally treat pediatric AHO given variable culture yields, evolving imaging tools, and emerging antibiotic resistance.
When a child presents with fever, point tenderness over a long bone metaphysis, and elevated CRP, start empiric anti-staphylococcal IV antibiotics after obtaining blood and local bone cultures, then transition to high-dose oral therapy once the CRP trends down — you don't need weeks of IV therapy.
If the child fails to improve within 48 hours or aspiration yields pus, that's your trigger for surgical debridement.