Pediatric osteoarticular infections (OAIs) are a significant cause of morbidity and can lead to severe orthopedic complications and long-term sequelae, if not promptly treated. Recent evidence increasingly favors shorter antibiotic courses in children with rapid clinical improvement, without compromising therapeutic outcomes. This study aimed tο assess the effectiveness of shorter length of antibiotics compared to prolonged treatment in pediatric population with uncomplicated OAIs. A systematic search was conducted in PubMed, Scopus, Web of Science and ClinicalTrial.gov. Studies including patients up to 19 years old that compared short-course with long-course antimicrobial treatment were eligible for inclusion. Due to variability in treatment durations across studies, no universal cut-off was applied; however, a subgroup analysis using a 25-day threshold was performed. Data were pooled and analyzed using DerSimonian-Laird random-effects and Mantel–Haenszel fixed-effects models. Thirteen studies (2,240 patients) were included in the analysis. Shorter course of antibiotic treatment was associated with a significantly lower observed risk of complications compared to longer courses. The pooled relative risk (RR) for complications with short-course therapy was 0.50 (95% CI: 0.28–0.89, p = 0.022) using the random-effect model and 0.44 (95% CI: 0.30–0.65) using the fixed-effects model, with low heterogeneity (I2 = 26.2%, p = 0.18). In a subgroup analysis of studies with a total treatment duration < 25 days (5 studies, 778 children), short-course therapy was associated with a reduced risk of complications (RR = 0.20; 95% CI: 0.06–0.61; p = 0.016, I2 = 0%).Conclusions: Short course antibiotic treatment for pediatric OAIs appears to be as effective as longer regimens and is associated with fewer sequelae in uncomplicated cases with clinical improvement. These findings could inspire more randomized studies and ultimately contribute to reducing hospitalization duration and healthcare costs.<Table Float="No" ID="Taba"> <tgroup cols="1"> <colspec align="left" colname="c1" colnum="1" /> <tbody> <row> <entry align="left" colname="c1"> What is Known: • Guidelines for osteoarticular infections treatment require prompt and prolonged antibiotic therapy. • Evidence regarding the optimal duration of antibiotic therapy for pediatric acute osteoarticular infections remains limited. </entry> </row> <row> <entry align="left" colname="c1"> What is New: • Short course antibiotic treatment for pediatric osteoarticular infections appears to be as effective as longer regimens and is associated with fewer sequelae in uncomplicated cases with clinical improvement. • Total treatment duration < 25 days is associated with a reduced risk of complications. </entry> </row> </tbody> </tgroup> </Table>

Short- versus long-course of antimicrobial treatment in pediatric population with acute osteoarticular infections: a systematic review and meta-analysis

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发表日期：

2026年7月8日

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Maria Maroudia Berikopoulou,
Argyro Konstantopoulou,
Konstantina Dimopoulou,
Ioannis Tsoliakos,
Panagiota Psallida,
Dimitra Dimopoulou

摘要

Pediatric osteoarticular infections (OAIs) are a significant cause of morbidity and can lead to severe orthopedic complications and long-term sequelae, if not promptly treated. Recent evidence increasingly favors shorter antibiotic courses in children with rapid clinical improvement, without compromising therapeutic outcomes. This study aimed tο assess the effectiveness of shorter length of antibiotics compared to prolonged treatment in pediatric population with uncomplicated OAIs. A systematic search was conducted in PubMed, Scopus, Web of Science and ClinicalTrial.gov. Studies including patients up to 19 years old that compared short-course with long-course antimicrobial treatment were eligible for inclusion. Due to variability in treatment durations across studies, no universal cut-off was applied; however, a subgroup analysis using a 25-day threshold was performed. Data were pooled and analyzed using DerSimonian-Laird random-effects and Mantel–Haenszel fixed-effects models. Thirteen studies (2,240 patients) were included in the analysis. Shorter course of antibiotic treatment was associated with a significantly lower observed risk of complications compared to longer courses. The pooled relative risk (RR) for complications with short-course therapy was 0.50 (95% CI: 0.28–0.89, p = 0.022) using the random-effect model and 0.44 (95% CI: 0.30–0.65) using the fixed-effects model, with low heterogeneity (I² = 26.2%, p = 0.18). In a subgroup analysis of studies with a total treatment duration < 25 days (5 studies, 778 children), short-course therapy was associated with a reduced risk of complications (RR = 0.20; 95% CI: 0.06–0.61; p = 0.016, I² = 0%).

Conclusions: Short course antibiotic treatment for pediatric OAIs appears to be as effective as longer regimens and is associated with fewer sequelae in uncomplicated cases with clinical improvement. These findings could inspire more randomized studies and ultimately contribute to reducing hospitalization duration and healthcare costs.

What is Known:

• Guidelines for osteoarticular infections treatment require prompt and prolonged antibiotic therapy.

• Evidence regarding the optimal duration of antibiotic therapy for pediatric acute osteoarticular infections remains limited.

What is New:

• Short course antibiotic treatment for pediatric osteoarticular infections appears to be as effective as longer regimens and is associated with fewer sequelae in uncomplicated cases with clinical improvement.

• Total treatment duration < 25 days is associated with a reduced risk of complications.