A 6-year-old child with sickle cell anemia presents with fever and tibial tenderness; which is the most appropriate initial treatment?

• A. Aspirin.
• B. Cefotaxime.
• C. Codeine.
• D. Norfloxacin.

Answer: (B)

In a child with sickle cell disease, fever plus focal bone pain strongly suggests osteomyelitis, so the first step is immediate empiric IV antibiotics that cover the common pathogens in this group, notably Salmonella and Staphylococcus aureus. A third-generation cephalosporin like cefotaxime provides broad coverage against these organisms and penetrates bone well, making it an appropriate initial therapy while cultures are obtained.

Aspirin isn’t an antibiotic and isn’t used to treat osteomyelitis in children (and has Reye’s risk). Codeine is only an analgesic and won’t treat the infection. Norfloxacin is generally avoided in children due to potential cartilage effects and isn’t the preferred initial agent for pediatric osteomyelitis.