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Osteomyelitis — RACP Paediatrics MCQ

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ModerateIDOsteomyelitisRACP Paediatrics

A 5-year-old presents with 3 days of right leg pain and refusal to weight-bear. There is point tenderness over the distal femoral metaphysis with warmth and swelling. Temperature is 39°C. CRP is 85 mg/L. Blood cultures are taken. What is the most appropriate initial antibiotic?

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Correct answer: A — IV flucloxacillin

Acute haematogenous osteomyelitis in children most commonly involves the metaphysis of long bones. Staphylococcus aureus is the most common organism. IV flucloxacillin is the first-line empirical antibiotic per Australian Therapeutic Guidelines. If MRSA is suspected (prior MRSA colonisation, poor response), IV vancomycin should be added.

Reference: Australian Therapeutic Guidelines – 2024 – Antibiotic; RCH Melbourne – 2023 – Osteomyelitis CPG