**6. Treatment**

Successful cure of osteomyelitis during the newborn period is dependent on a fast and true diagnosis and sufficient treatment. Empirical selection of antibiotic therapy depends on the age and the clinical situation of the infant. Antimicrobial therapy should be started as soon as the diagnosis is made and directed against the most common bacterial isolates responsible for hematogenous osteomyelitis according to age group. Delay in therapy commencement increases the risk for complications. If a definitive organism is isolated, antimicrobial treatment should be accordingly adjusted.

For neonates an empiric regimen should include excellent coverage against S. aureus, group B streptococcus and enteric gram-negative bacteria, thus consisting of a third-generation cephalosporin (cefotaxime) plus an antistaphylococcal agent (amoxicillin). Infants at risk for hospital-acquired infection (methicillin-resistant or coagulase negative Staphylococcus aureus) should receive vancomycin instead of amoxicillin.

Duration of treatment depends on the extent of infection, the clinical response and the presence of underlying risk factors [51]. In the case of unifocal osteomyelitis continuation of treatment for six weeks and in the case of complex disease, defined as multifocal, significant bone destruction, resistant unusual pathogen, septic shock, continuation for more than six weeks to months might be required. Antimicrobial treatment is frequently administered intravenously for two to three weeks and then switched to oral medication [52]. Surgery is indicated to drain acute abscesses or when no improvement is achieved with antibiotic treatment.
