Table 5

Pragmatic UK practice note for oral switch criteria and length of antibiotic therapy in OM and SA with current absence of high quality clinical trial data

Unifocal diseaseComplex disease*PVL positive
Neonatal to <3 monthsConsider intravenous to oral switch after 14–21 days if: afebrile+pain free for at least 24 h and CRP <20 or CRP decreased by ≥2/3 of highest valueConsider intravenous to oral switch after 21 days if: afebrile+pain free for at least 48 h and CRP <20Consider intravenous to oral switch after 21 days if: afebrile+pain free for at least 48 h and CRP <20
Minimum 14–21 days intravenousMinimum 14–21 days intravenousMinimum 14–21 days intravenous
Child ≥ 3 monthsConsider intravenous to oral switch after 48 h if: afebrile+pain free for at least 24 h and CRP <20 or CRP decreased by ≥2/3 of highest valueConsider intravenous to oral switch after 14 days if: afebrile+pain free for at least 48 h and CRP <20; significant bone destruction often requires ≥6 weeks intravenousConsider intravenous to oral switch after 21 days if: afebrile+pain free for at least 48 h and CRP <20 until inflammatory markers return to normal and infection is controlled
Minimum 48 h intravenousMinimum 48 h intravenousMinimum 48 h intravenous
OM total length of therapy≤3 Months of age: treat for 6 weeksAll age groups: treat for ≥6 weeks to many months, tailor to individual responseAll age groups: treat for ≥6 weeks
≥3 Months of age: treat for 4–6 weeksCRP (±ESR) returned to normal
≤3 Months of age: treat for 6 weeks
SA total length of therapy≥3 Months of age: treat for 3 weeksAll age groups: treat for ≥6 weeks to many months, tailor to individual responseAll age groups: treat for ≥6 weeks
  • * Any of: multifocal; significant bone destruction; resistant/unusual pathogen; immunosuppressed; sepsis or shock.

  • CRP, C reactive protein; ESR, erythrocyte sedimentation rate; OM, osteomyelitis; PVL, Panton-Valentine leukocidin; SA, septic arthritis.