Paediatric osteomyelitis: new indications for treating the bone infection

Paediatric osteomyelitis: a guide for paediatricians on appropriate diagnosis and treatment from leading Italian experts, coordinated by Bambino Gesù. Study published in the Italian Journal of Pediatrics

It is a bacterial infection that creeps into the bones of children, 4 per 100,000.

If not well treated, it can have very serious consequences.

It is uncomplicated acute haematogenous osteomyelitis, for the treatment of which, until now, only fragmentary and very heterogeneous indications were available.

A study coordinated by the Bambino Gesù Paediatric Hospital has provided a new tool for paediatricians.

By analysing the existing scientific literature, Italy’s leading experts have identified the most effective therapies to avoid unnecessary, prolonged hospitalisation and, above all, degeneration of the disease.

The study, published in the Italian Journal of Pediatrics, is open access and contains a series of tables with the classification of the bacteria that cause the infection, the most suitable antibiotics, dosages, times and methods of administration.


Haematogenous osteomyelitis is an infection caused by a large number of bacteria (staphylococcus being one of the most common) penetrating and corroding the bones through fractures, wounds or infections in other parts of the body.

It mainly affects prepubertal children, about 3-4 per 100,000, is most common in the bones of the limbs and manifests itself with a wide variety of symptoms including fever, pain in the area of infection, swelling and difficulty in moving.

Detection of the bacteria responsible is often complex: pending the outcome of laboratory and imaging investigations, children with osteomyelitis are given empirical treatment and then move on to specific treatment.

Early diagnosis and appropriate treatment are essential to minimise the risk of serious complications.


The systematic analysis of the scientific literature on ‘uncomplicated acute haematogenous osteomyelitis’ lasted about two years and was coordinated by the Bambino Gesù, the centre that today manages the largest national casuistry (about 80 children a year).

The study, the first in Italy and one of the few in the world on such a large scale, examined over 4,500 scientific articles.

The review was carried out by a group of 40 specialists, paediatricians and orthopaedists, from various Italian hospitals and universities with the support of three scientific societies (SIP – Italian Society of Paediatrics, SITIP – Italian Society of Paediatric Infectious Diseases and SITOP – Italian Society of Paediatric Traumatology and Orthopaedics).


The result of the study is a guide for paediatricians: clear and shared indications for managing the infection by intervening rapidly with targeted diagnostic tests and appropriate therapies.

The tables included in the study list the most common bacteria in Italy (the pathogens responsible for the disease vary from country to country), describe the degree of efficacy (bone penetration) of antibiotics, indicate the most appropriate easily available, low-cost and easy-to-use drugs for each age group, the timing and method of administration (oral, intravenous).

The work also contains specific recommendations for empirical therapy, which is a crucial step in the treatment process, while waiting to find out which bacterium is responsible for the infection.

Andrzej Krzysztofiak, paediatrician of Infectious Diseases and Immunoinfectious Diseases of the Bambino Gesù, first author of the study, stresses: “The work of experts from all over Italy finally puts order in the variety of indications on the treatment of bacterial osteomyelitis, a disease with many forms, complex to recognise and treat.

The time factor, on the other hand, is very important to avoid repeated hospitalisations and, above all, disabling complications.

Today there are few international guidelines, which are not adapted to the epidemiological situation in Italy.

With our study, we wanted to give paediatricians and orthopaedists a common guideline for dealing effectively with this insidious infection”.



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