Temple University School of Podiatric Medicine Journal Review Club

Editor's note: This post is part of the Temple University School of Podiatric Medicine (TUSPM) journal review club blog series. In each blog post, a TUSPM student will review a journal article relevant to wound management and related topics and provide their evaluation of the clinical research therein.

Article title: Antibiotic Treatment and Surgery for Acute Hematogenous Calcaneal Osteomyelitis of Childhood
Authors: Markus Pääkkönen, MD, Markku J.T. Kallio, MD, Heikki Peltola, MD, Pentti E. Kallio, MD
Journal name and issue: The Journal of Foot and Ankle Surgery, September-October 2015 (pages 840-843).
Reviewed by: Rizwan Tai, Temple University School of Podiatric Medicine Class of 2016

Introduction

The authors of this study hypothesized that 2 to 4 days of intravenous treatment followed by an oral treatment for a total of 20 days would be an adequate treatment plan for any uncomplicated cases of calcaneal Acute Hematogenous Osteomyelitis (AHOM) in childhood. Approximately 9% to 11% of AHOM in children involves the calcaneus and frequently presenting in a subtle and insidious fashion in contrast to other anatomical sites.

Materials and Methods

The authors only included the subjects in the study if the pathology was isolated to calcaneal bone. If there were bacterial findings in blood only then there must be clinical signs and symptoms or radiographic findings evident in calcaneal bone to be part of the study. The participants ranged from ages 3 months to 15 years. Immunodeficient children or anyone who had underlying illness were excluded. They divided the participants into two groups and either received clindamycin (40mg/kg/day) or a first-generation cephalosporin (150mg/kg/day). Each dose was divided into 4 equal doses. The participants were given intravenous dose for 2 to 4 days and then depending on clinical signs and C-reactive protein (CRP) they were transitioned to oral regimen. The follow-up periods were 2 weeks, 3 months, and 1 year after discharge. The authors based the success of the treatment on the clinical signs, radiographic findings, and the results of CRP.

Results

11 children were part of the study. In 10 patients the bacteria identified was Staphylococcus aureus sensitive to methicillin and in one patient Streptococcus pneumonia was identified. 5 participants were randomized to a 20-day and 6 to a 30-day antibiotic course, and 5 were given clindamycin and 6 were given first-generation cephalosporin. The authors did not find any difference in recovery between the two methods of treatment, short or long, and none of the patients required another course of treatment due to relapse.

Discussion

The authors found that all the participants in this study were fully healed with a maximum treatment for 30 days of 4-times day with clindamycin or first-generation cephalosporin. However, in this particular study the participants were given a higher dose than normally given. The authors concluded that it is sufficient for ful recovery to prescribe a 3-week dose antibiotic treatment. A 4-week treatment course was suggested if the AHOM was to spread to adjacent joints or tissue. It is paramount for the antibiotic treatment to be initiated at the earliest presentation and stages of AHOM for an uneventful recovery.

About the Authors:
Rizwan Tai is a third year podiatric medical student at Temple University in Philadelphia, Pennsylvania. He graduated from the University of Houston in 2011 with a Bachelor of Business Administration and a minor in Biology. His interest in podiatry was sparked after a close relative of his suffered from amputations of toes secondary to diabetic complications, and his mother suffering from plantar fascia pain.

Dr. James McGuire is the director of the Leonard S. Abrams Center for Advanced Wound Healing and an associate professor of the Department of Podiatric Medicine and Orthopedics at the Temple University School of Podiatric Medicine in Philadelphia.