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Osteomyelitis
Introduction
Osteomyelitis is an infection of the bone, and is most common in children under 12 years. Staphylococci are the most frequent responsible organisms. Salmonella osteomyelitis infection is a common complication of sickle cell disease. Tuberculosis osteomyelitis occurs in association with having tuberculosis.
Signs and symptoms
Diagnostic Criteria
• Fever, malaise and severe pain at the site of bone infection in acute osteomyelitis
• If the infection is close to a joint there may be a ‘sympathetic’ effusion
Investigation
• Total and differential WBC
• CRP
• Urinalysis, urine for culture and sensitivity
• Blood for culture and sensitivity
• Pus for culture and sensitivity
• Plain X-ray (Note: The first radiological sign appears 12–14 days after onset).
Treatment
-
Pharmacological
- For acute osteomyelitis
• Cloxacillin (IV) 1–2 g 6 hourly
Or
• Clindamycin (IV) 600 mg 8 hourly.
Duration is 6 weeks or stop at 3 weeks if X-ray finding is normal
For Chronic osteomyelitis
• Surgery. Antibiotics not generally recommended
For Osteomyelitis in patient with sickle cell anemia
• Ampicillin (IV) 2 g 6 hourly for 5 to 12 weeks
Plus
• Cloxacillin (IV) 1–2 g 6 hourly for 6 to 12 weeks
Plus
• Chloramphenicol (IV) 500 mg 6 hourly (if salmonella is suspected) for 2 to 3 weeks
For Septic arthritis
• Cloxacillin for 6 days or
• Clindamycin for 7 days as for acute osteomyelitis
For Gonococcal arthritis
• Benzyl penicillin (IV) 2.5–5 MU 6 hourly or (if penicillin resistant) for 3 days
• Kanamycin (IM) 2 g once daily for 3 days
For Open fracture (no infection established)
• Cloxacillin (IV) 1 g 6 hourly for 3 days
Or
• Clindamycin (IV) 600 mg 8 hourly for 3 days
• Ceftriaxone 1 g 8 hourly for 3 days
-
Non-pharmacological
- For acute osteomyelitis
• Surgical drainage (recommended in all cases presenting with history > 24 hours)
For Septic arthritis
• Surgical drainage
Prevention
Updated on,
6 Novemba 2020, 08:13:34
References
- 1. STG
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