The treatment of osteomyelitis due to Staphylococcus aureus was evaluated by randomized trial in 12 children who received clindamycin and 13 children who received nafcillin or methicillin. In the nafcillin/methicillin group, the mean duration of intravenous (IV) therapy was 27 days (range 14 to 38 days) plus 3.7 weeks (range 0 to 8 weeks) of oral therapy with dicloxacillin. In the clindamycin group, the mean duration of IV therapy was 5.8 days (range three to ten days) plus 4.7 weeks (range three to nine weeks) of oral therapy with clindamycin. The geometric means (GMs) of peak serum bactericidal titers for IV therapy were 45 (range 16 to 256) and seven (2 to 256) for nafcillin/methicillin and clindamycin respectively. The GMs of peak serum inhibitory and bactericidal titers for oral therapy with clindamycin were 99 (range 16 to 512) and four (range 1 to 128) and were generally within one dilution of the IV titer. The outcome of therapy was excellent for ten children in the nafcillin/methicillin group and for 11 children in the clindamycin group. In the clindamycin group, the outcome did not correlate with achieving a peak bactericidial titer of ≥1:8. Clindamycin administered IV until the patient is afebrile for three consecutive days and then orally for approximately four weeks is an alternative to nafcillin/methicillin in the therapy of S aureus osteomyelitis in children.
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