Short-Course IV Antibiotics Effective for Pediatric Bone and Joint Infections: Study

A comprehensive literature review from prominent international medical literature databases such as MEDLINE, CENTRAL, and Scopus, taking into account all relevant publications that emerged until December 31, 2024. In particular, the researchers conducted a screening of only clinical studies that had involved previously healthy infants and children more than 3 months of age suffering from acute and uncomplicated BJIs that had been treated with 5 or less days of primary intravenous antibiotics.

To eliminate extraneous factors that might influence the results of analysis, only those articles were included in the review whose authors did not involve patients with any preexisting diseases, patients with indwelling prosthetic joints, or patients with infections at complex surgical sites. Assessing methodological quality and risk of biases in each study included in the review was conducted by means of RoB-2 and ROBINS-I scales, whereas the overall certainty of medical evidence was evaluated with GRADE.

Key findings:

• In the systematic review, all collected data of 6 individual clinical trials involving a total number of 813 children were critically assessed.
• Three studies out of the 6 analyzed studies met all the statistical criteria and were suitable for pooling in the meta-analysis.
• The pooled odds ratio of having complete success of treatment with either the short course of intravenous treatment lasting up to 5 days or using only the oral treatment regimen versus the traditional intravenous treatment protocol is found to be 1.65.
• The 95% confidence interval of the success measure is estimated within the range of 0.46 and 5.98, implying that there is no statistically significant difference in the results between the two interventions.
• The level of statistical heterogeneity among pooled studies was extremely low, showing I2 value of exactly 0%.
• Given the sample size imprecision and a small number of estimate studies, the certainty of evidence of success was assessed as low according to the GRADE approach.

Overall, the systematic review and meta-analysis demonstrate that a short intravenous regimen or a purely oral treatment may prove to be equally efficacious in healthy children with uncomplicated BJI. Nevertheless, considering the low quality of the evidence, it is reasonable to use these treatment approaches very carefully.

Reference:

Vroutsi, Marina MD, MSc^*; Soldatou, Alexandra MD, PhD^*; Psallida, Panagiota MSc^†; Tsolia, Maria MD, PhD^*. Short-course Intravenous Antibiotic Therapy of Pediatric Acute Bone and Joint Infections: A Systematic Review and Meta-analysis. The Pediatric Infectious Disease Journal ():10.1097/INF.0000000000005248, April 27, 2026. | DOI: 10.1097/INF.0000000000005248