Bone and joint infections in children.

Recent reports of joint and bone infections in children have provided several new insights into prompt and accurate diagnosis of these potentially destructive processes. In the HIV era, some reports have focused specifically on musculoskeletal infections at unusual sites with unusual organisms. Other reports further document the fascinating and perplexing entity of chronic recurrent multifocal osteomyelitis. Several new treatment trends are worth noting. Acute staphylococcal osteomyelitis in many children may be better treated at reduced costs by minimizing surgical intervention, shortening the duration of antibiotic courses and hospital stays, switching quickly to the oral route for antibiotics, and not using serum bactericidal levels. Early Lyme disease, Lyme arthritis, and neuroborreliosis may respond just as well to oral doxycycline as to intravenous ceftriaxone at a much lower cost and a decreased risk of complications.