Treatment of acute hematogenous osteomyelitis in childhood: a literature review

Abstract

Acute hematogenous osteomyelitis in childhood requires timely treatment to reduce complications and long-term sequelae. This review aimed to examine antimicrobial selection, transition to oral therapy, treatment duration, and surgical source control. This is a narrative literature review based on guidelines, a randomized trial, systematic reviews, and observational studies. The literature assessment reported in the original manuscript on October 19, 2026, was supplemented by source verification on October 27, 2026, without a new systematic selection process or an original meta-analysis. The evidence supports early transition to oral antibiotics in clinically stable children with a favorable response and reliable adherence and follow-up. A total treatment duration of three to four weeks remains a reference for uncomplicated Staphylococcus aureus disease within the scope of the PIDS/IDSA guideline. Initial oral treatment has shown promising results in selected populations, but these findings should not be generalized to severe disease, neonates, or patients with comorbidities. Drainage and debridement depend on disease severity, collections, and clinical progression. Treatment simplification therefore requires individualized assessment, source control, and reliable monitoring, while distinguishing a shorter intravenous phase from a shorter total course.