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Trimethoprim-sulfamethoxazole Therapy for Children With Acute Osteomyelitis

Messina, Allison F. MD*; Namtu, Katie PharmD; Guild, Michelle PharmD; Dumois, Juan A. MD*; Berman, David M. DO*

Pediatric Infectious Disease Journal: December 2011 - Volume 30 - Issue 12 - p 1019–1021
doi: 10.1097/INF.0b013e31822db658
Original Studies

Background: The emergence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) has complicated the conventional management of osteomyelitis. While oral clindamycin is commonly used to treat acute CA-MRSA osteomyelitis, the emergence of inducible clindamycin resistance among CA-MRSA isolates has made alternative therapy necessary. The excellent oral bioavailability, susceptibility profile, favorable palatability, and low cost of trimethoprim-sulfamethoxazole (TMP-SMX) make this drug an attractive option for treating osteomyelitis, yet its clinical efficacy for osteomyelitis has not been established.

Methods: Between October 1998 and September 2009, 20 children who received a TMP-SMX–containing regimen for acute osteomyelitis at All Children's Hospital were identified from hospital records, and their cases reviewed for clinical outcome and drug safety.

Results: Patients ranged in age from 9 months to 17 years. Twelve (60%) of the patients were male. Causative pathogens were found in 8 (40%) cases of which 5 were CA-MRSA and 3 were methicillin-susceptible Staphylococcus aureus. Eleven patients (55%) received TMP-SMX as their primary therapy. The median dose of TMP-SMX was 16.4 mg/kg/d. During TMP-SMX therapy, 8 patients (40%) experienced adverse events; all were considered mild. Duration of total therapy was 26 to 59 days, with a median of 40 days. All 20 patients were considered cured of their infection at the end of therapy.

Conclusion: Orally administered TMP-SMX appears to be a useful and well-tolerated therapy for treatment of acute osteomyelitis in children. Further prospective comparative studies will be needed to confirm this observation.

From the Departments of *Pediatrics Division of Infectious Diseases and †Pharmacy, All Children's Hospital/Johns Hopkins Medicine, Saint Petersburg, FL.

Accepted for publication July 14, 2011.

A.F.M. and K.N. contributed equally to this manuscript.

The authors have no funding or conflicts of interest to disclose.

Address for correspondence: Allison F. Messina, MD, All Children's Hospital, 601 5th St South, OCC 5th Floor, Saint Petersburg, FL 33701. E-mail: allison.messina@allkids.org.

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© 2011 Lippincott Williams & Wilkins, Inc.