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In the preantibiotic era, acute hematogenous osteomyelitis was a dreaded scourge, progressing inexorably to joint destruction and deformity. Therapy is now readily available to eradicate the infection and prevent its disabling sequelae, but diagnosis must be made early, ie, within the first 24 to 48 hours. Dr Zack reviews the common and not so common symptoms, evaluates diagnostic tests, and suggests appropriate antibiotic regimens. In addition, he touches on some controversial questions in management, eg, How valuable is gallium scanning? When can antibiotic therapy be safely switched from parenteral to oral agents?