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MANAGEMENT STRATEGIES TO PREVENT PURULENT COMPLICATIONS IN
PEDIATRIC HEMATOGENOUS OSTEOMYELITIS
Khaydarov Gayrat Melikuzievich
Department of operative surgery, FMIOPH, Fergana, Uzbekistan
Obidova Tursunoy Olim kizi
Student of FMIOPH, Fergana, Uzbekistan
Eminov Ravshanjon Ikromjon ugli
Department of Faculty and hospital surgery, FMIOPH, Fergana, Uzbekistan
Abstract:
The prevention of purulent complications in pediatric hematogenous osteomyelitis
requires a comprehensive approach. Effective antibiotic therapy, including both intravenous
and oral regimens, is essential. Lifestyle measures such as rest, nutrition, and hygiene support
recovery. Surgical interventions like debridement and local antibiotic delivery are necessary in
complicated cases. Early diagnosis and multidisciplinary management improve outcomes and
reduce long-term complications.
Keywords
: osteomyelitis, antibiotics, surgery, children
Аннотация::
Профилактика гнойных осложнений при гематогенном остеомиелите у
детей требует комплексного подхода. Эффективная антибактериальная терапия
включает внутривенное и пероральное лечение. Образ жизни, включая отдых, питание и
гигиену, способствует выздоровлению. Хирургическое вмешательство, такое как
некрэктомия и локальная доставка антибиотиков, необходимо при осложнениях. Ранняя
диагностика и мультидисциплинарное лечение улучшают прогноз и снижают риск
осложнений.
Ключевые слова:
остеомиелит, антибиотики, хирургия, дети
Annotatsiya
Bola yoshidagi gematogen osteomiyelitda yiringli asoratlarning oldini olish uchun kompleks
yondashuv zarur. Effektiv antibiotik davosi (vena ichiga va og'iz orqali) asosiy davolash
hisoblanadi. Dam olish, ovqatlanish va gigiena kabi turmush tarzidagi choralar sog‘ayishni
qo‘llab-quvvatlaydi. Murakkab holatlarda debridement va lokal antibiotik yuborish kabi
jarrohlik aralashuvlari talab qilinadi. Erta tashxis va ko‘p tarmoqli yondashuv natijalarni
yaxshilaydi va uzoq muddatli asoratlarni kamaytiradi.
Kalit so‘zlar:
osteomiyelit, antibiotiklar, jarrohlik, bolalar
Introduction
The prevention of purulent complications in hematogenous osteomyelitis in children involves a
multifaceted approach that includes medical treatments, lifestyle interventions, and surgical
strategies. Medical management primarily focuses on the use of antibiotics, with traditional
agents like vancomycin and clindamycin being effective against methicillin-resistant
Staphylococcus aureus (MRSA), a common pathogen in pediatric acute hematogenous
osteomyelitis (AHO)[2] [3]. Newer antibiotics such as daptomycin, linezolid, and ceftaroline
are also emerging as viable options[2]. Antimicrobial stewardship programs play a crucial role
in optimizing antibiotic selection, dosing, and transition from intravenous to oral therapy,
which is essential for effective treatment and prevention of chronic osteomyelitis[10]. Lifestyle
interventions, although not explicitly detailed in the literature, would logically include ensuring
adherence to prescribed antibiotic regimens and maintaining good hygiene to prevent infections.
Surgical interventions are critical, especially in cases where there is abscess formation or
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necrotic tissue. Surgical debridement, which involves the removal of infected and dead tissue,
is often necessary to prevent complications and facilitate recovery[5]. This procedure is
complemented by the use of antibiotic-impregnated materials, such as calcium sulphate pellets,
to manage dead space and deliver high local concentrations of antibiotics[9]. The decision to
perform surgery varies significantly across institutions, influenced by factors such as the
severity of infection and institutional practices[6]. Early diagnosis and prompt initiation of
treatment, whether medical or surgical, are crucial to prevent long-term complications such as
chronic osteomyelitis, growth disturbances, and limb length discrepancies[1]. Overall, a
multidisciplinary approach involving pediatricians, infectious disease specialists, and
orthopedic surgeons is essential for the effective management and prevention of purulent
complications in pediatric osteomyelitis[1] [7].
Medical Treatments
Antibiotic Therapy
Antibiotic therapy is the cornerstone of treatment for AHO. The choice of antibiotics depends
on the causative organism, with Staphylococcus aureus being the most common pathogen.
Empirical therapy is often initiated before culture results are available, with considerations for
methicillin-resistant Staphylococcus aureus (MRSA) in regions where it is
prevalent [4] [7] [18].
Intravenous (IV) Antibiotics: Initial treatment typically involves IV antibiotics such as
vancomycin, clindamycin, or cefazolin for 4-6 weeks. This ensures high bioavailability and
rapid penetration into bone tissue [2] [3] [4].
Oral Antibiotics: Once clinical improvement is observed (e.g., reduced fever,
normalization of C-reactive protein (CRP)), oral antibiotics such as amoxicillin/clavulanate or
cefalexin may be used to complete the course [3] [4] [7].
Duration of Therapy: The total duration of antibiotic therapy is typically 3-4 weeks for
uncomplicated cases, but may extend to 4-6 weeks for more severe infections or those
involving the pelvis or spondylodiscitis [4] [7].
Adjunctive Treatments
Pain Management: Adequate pain control is essential to improve the child's comfort and
mobility [5] [14].
Immobilization: Rest and immobilization of the affected limb can reduce further injury
and promote healing [5] [14].
Table
: Comparison of treatment modalities for AHO
Treatment Modality
Description
Citatio
n
Antibiotic Therapy
IV antibiotics (e.g., vancomycin, cefazolin) for 4-6
weeks, followed by oral antibiotics
[2] [3] [
4]
Surgical Debridement
Removal of necrotic bone and infected tissue to
prevent chronic infection
[10] [1
1] [15]
Immobilization and Rest
Reduces further injury and promotes healing
[5] [14]
Antibiotic-Impregnated
Calcium Sulfate
Local delivery of antibiotics to infection site
[12] [1
3]
Lifestyle Interventions
Immobilization and Rest
Immobilization is crucial to prevent further damage to the infected bone and surrounding
tissues. This is particularly important in the acute phase to reduce pain and
inflammation [5] [14].
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Nutritional Support
Proper nutrition is essential for healing. A balanced diet rich in vitamins and minerals,
particularly vitamin C and zinc, can support the immune system and promote bone
repair [5] [14].
Hygiene and Wound Care
In cases where surgical intervention is required, proper wound care and hygiene are vital to
prevent secondary infections and promote healing [10] [13].
Surgical Approaches
Indications for Surgery
Surgical intervention is reserved for cases where medical therapy alone is insufficient.
Common indications include:
Subperiosteal or intraosseous abscesses: These require drainage to prevent the spread of
infection [9] [10] [17].
Necrotic Bone: Debridement of necrotic tissue is necessary to eliminate the infection
source [10] [11].
Surgical Debridement: This involves the removal of dead bone and infected soft tissue,
which is critical for preventing chronic osteomyelitis [10] [11] [15].
Surgical Techniques
Debridement and Drainage: The primary goal is to remove infected tissue and drain
abscesses. This is often performed in conjunction with antibiotic therapy [10] [11].
Antibiotic-Impregnated Calcium Sulfate: This technique involves placing antibiotic-
impregnated beads or pellets at the infection site to deliver high concentrations of antibiotics
locally. This method has shown promising results in reducing recurrence rates [12] [13].
Stabilization and Reconstruction: In cases of pathological fractures or bone instability,
surgical stabilization may be required to restore function and promote healing [10] [13].
Preventing Purulent Complications
Early Diagnosis and Treatment
Early diagnosis and initiation of treatment are critical to preventing purulent complications.
Delayed treatment can lead to abscess formation, bone necrosis, and chronic
osteomyelitis [6] [14] [15].
Monitoring and Follow-Up
Regular monitoring of clinical and laboratory parameters, such as CRP levels and imaging
studies, is essential to assess treatment response and detect early signs of
complications [4] [7] [16].
Multidisciplinary Approach
AHO management requires a multidisciplinary team, including pediatricians, infectious disease
specialists, orthopedic surgeons, and radiologists. This collaborative approach ensures
comprehensive care and optimal outcomes [5] [7] [14].
Conclusion
The prevention of purulent complications in hematogenous osteomyelitis in children requires a
combination of prompt medical treatment, appropriate lifestyle interventions, and, when
necessary, surgical intervention. Early diagnosis, tailored antibiotic therapy, and surgical
debridement are key to achieving favorable outcomes and minimizing long-term sequelae.
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