From the Guidelines
For bacterial myositis (pyomyositis) in children, vancomycin is recommended for initial empirical therapy, with an agent active against enteric gram-negative bacilli added for infection in immunocompromised patients or following open trauma to the muscles 1.
Key Considerations
- The choice of antibiotic depends on the underlying cause of myositis, with not all cases being bacterial in nature.
- For pyomyositis caused by Methicillin-Susceptible Staphylococcus aureus (MSSA), cefazolin or an antistaphylococcal penicillin (such as nafcillin or oxacillin) is recommended 1.
- It is crucial to obtain blood and abscess cultures before starting antibiotics and to consider surgical drainage for abscesses.
- Treatment duration is typically 2-3 weeks, with intravenous antibiotics initially, transitioning to oral antibiotics once the patient shows clinical improvement 1.
Important Notes
- Most cases of myositis in children are viral or autoimmune, not requiring antibiotic treatment.
- A thorough evaluation, including blood work, imaging, and possibly muscle biopsy, is essential to determine the cause before initiating treatment.
- Supportive care with rest, hydration, and pain management is important regardless of the underlying cause.
Antibiotic Choices
- Vancomycin for initial empirical therapy, especially for MRSA coverage.
- Cefazolin or antistaphylococcal penicillins for MSSA pyomyositis.
- Consider adding an agent active against enteric gram-negative bacilli in specific cases, as recommended by guidelines 1.
From the Research
Antibiotic Treatment for Myositis in Children
There is no direct evidence to support the use of antibiotics for the treatment of myositis in children, as myositis is typically an autoimmune or inflammatory condition rather than a bacterial infection.
- The study 2 discusses the management of benign acute childhood myositis, which is often associated with viral infections, and recommends treatment with hydration, rest, analgesics, and careful follow-up, rather than antibiotics.
- The other studies 3, 4, 5, 6 focus on the treatment of myositis in general, with an emphasis on immunosuppressive therapy, glucocorticoids, and exercise, but do not specifically address the use of antibiotics in children.
Treatment Approach
The approach to treating myositis in children typically involves:
- Identifying and managing any underlying viral or other infections 2
- Using immunosuppressive therapy and glucocorticoids to reduce inflammation and disease activity 4, 6
- Implementing individualized and supervised exercise programs to improve muscle performance 4
Important Considerations
It is essential to note that myositis can have various causes, including infections, drugs, rheumatologic diseases, and malignancies 5, and treatment should be tailored to the specific underlying cause. In the case of bacterial infections, antibiotics may be necessary, but this is not typically the primary treatment approach for myositis.