Medication
Without surgical resection of infected bone, antibiotic treatment must be prolonged (≥4 to 6 weeks). Advances in surgical technique have increased the potential for bone (and often limb) salvage and infection remission. Conclusions: Osteomyelitis is best managed by a multidisciplinary team. It requires accurate diagnosis and optimization of ...
Procedures
Background: Chronic osteomyelitis is generally treated with antibiotics and surgical debridement but can persist intermittently for years with frequent therapeutic failure or relapse. Despite advances in both antibiotic and surgical treatment, the long-term recurrence rate remains around 20%. This is an update of a Cochrane review first published in 2009.
Self-care
Most reported experience for treatment of ampicillin-resistant VRE osteomyelitis has been with linezolid. 41 Other agents used include chloramphenicol, tetracyclines, daptomycin, and quinupristin-dalfopristin. Tigecycline is also active against VRE. Linezolid resistance develops more frequently in enterococci than in staphylococci.
Nutrition
Intravenous or oral antibiotic treatment for osteomyelitis may be very extensive, lasting for many weeks. It is important for the patient to continue to take antibiotics for as long as recommended by the treatment team, even after symptoms of the infection have resolved. Monitoring of successive X-rays and blood tests. Pain management
What is the best antibiotic for a bone infection?
The most commonly used antibiotics include gentamicin, tobramycin, and vancomycin.
What antibiotics are used for an infected tooth?
76 rows · The following list of medications are in some way related to or used in the treatment of this condition. Select drug class All drug classes amebicides (4) carbapenems (2) miscellaneous antibiotics (6) quinolones (6) aminoglycosides (7) first generation cephalosporins (3) second generation cephalosporins (6) third generation cephalosporins (6) penicillinase resistant …
What antibiotics are used for bone infections?
· Antibiotic regimens for the empiric treatment of acute osteomyelitis, particularly in children, should include an agent directed against S. aureus. Betalactam antibiotics are …
Should all infections be treated with antibiotics?
Osteomyelitis is an inflammation of the bone and bone marrow caused by pus-forming bacteria, mycobacteria or fungi. All bone infection that is long-standing is called chronic osteomyelitis. People with this condition are treated with systemic antibiotics, which can be given by mouth or parenterally (i.e. by injection into the muscle or vein).
Which antibiotic is best for osteomyelitis?
Oral antibiotics that have been proved to be effective include clindamycin, rifampin, trimethoprim-sulfamethoxazole, and fluoroquinolones. Clindamycin is given orally after initial intravenous (IV) treatment for 1-2 weeks and has excellent bioavailability.
What antibiotic is recommended for empiric treatment of osteomyelitis?
Beta-lactams and vancomycin are commonly used as initial empiric therapy. Suggested empiric antibiotic regimens include vancomycin in combination with a third- or fourth-generation cephalosporin or piperacillin-tazobactam.
What is the medication of choice in osteomyelitis?
Vancomycin has been the treatment of choice for methicillin-resistant Staphylococcus aureus osteomyelitis, but there are several newer parenteral and oral agents for treatment of methicillin-resistant Staphylococcus aureus including linezolid and daptomycin.
What is the best way to prevent osteomyelitis?
One way to prevent osteomyelitis is to keep skin clean. All cuts and wounds — especially deep wounds — should be cleaned well. Wash a wound with soap and water, holding it under running water for at least 5 minutes to flush it out. To keep the wound clean afterward, cover it with sterile gauze or a clean cloth.
Can oral antibiotics cure osteomyelitis?
In a recent literature review by Spellberg et al. it was concluded that oral and parenteral antibiotic therapy have similar cure rates for the treatment of chronic osteomyelitis. Oral antibiotic therapy is associated with a lower risk to the patient due to avoiding the need of a central IV line.
Is doxycycline good for osteomyelitis?
Tetracyclines (doxycycline and minocycline; both 100 mg twice daily) are lipophilic, thus, facilitating the passage into tissues. Evidence of efficacy is primarily in the treatment of skin and soft tissue infections and, to a lesser extent, for osteomyelitis.
What is the strongest oral antibiotic for bone infection?
The classic antibiotic combination for bone infections caused by Staphylococcus aureus and P. aeruginosa is levofloxacin plus rifampicin.
Can cephalexin be used for osteomyelitis?
Cloxacillin and cephalexin were the most commonly used oral drugs. Durations of therapy ranged from 3 to 8 weeks in the studies of acute osteomyelitis and 3 to 18 months for cases of chronic osteomyelitis.
Does Cipro treat osteomyelitis?
In conclusion, ciprofloxacin offers a well tolerated and efficacious alternative to injectable antibiotics for the treatment of Gram-negative osteomyelitis.
What bone is the most common site of osteomyelitis?
The most common site of infection is the metaphysis, which is the narrow portion of the long bone). In adults, the bones of the spinal column (vertebra) are often affected.
Can you get osteomyelitis twice?
Osteomyelitis is a difficult-to-cure infection with a high relapse rate despite combined medical and surgical therapies. Some severity factors, duration of antimicrobial therapy and type of surgical procedure might influence osteomyelitis relapse.
Does osteomyelitis ever go away?
Osteomyelitis is a painful bone infection. It usually goes away if treated early with antibiotics. If not, it can cause permanent damage.
Can levofloxacin treat osteomyelitis?
Levofloxacin has a long serum half-life and is currently given once a day in clinical practice. Therefore, levofloxacin may be an ideal agent for the treatment of osteomyelitis. In a recent clinical study, oral levofloxacin, lomefloxacin and ciprofloxacin were evaluated for treatment of chronic osteomyelitis.
Does Cipro treat osteomyelitis?
In conclusion, ciprofloxacin offers a well tolerated and efficacious alternative to injectable antibiotics for the treatment of Gram-negative osteomyelitis.
Can cephalexin be used for osteomyelitis?
Cloxacillin and cephalexin were the most commonly used oral drugs. Durations of therapy ranged from 3 to 8 weeks in the studies of acute osteomyelitis and 3 to 18 months for cases of chronic osteomyelitis.
Does Rocephin treat osteomyelitis?
Ceftriaxone is an effective and safe agent for the treatment of osteomyelitis. It is active against most of the causative organisms. Combined with surgery, it is useful for all types of osteomyelitis. In addition, its once-daily dosing has made outpatient therapy feasible for most patients.
Can antibiotics cause osteomyelitis?
Antibiotics for treating chronic osteomyelitis in adults. Limited and low quality evidence suggests that the route of antibiotic administration (oral versus parenteral) does not affect the rate of disease remission if the bacteria are susceptible to the antibiotic used.
Does oral antibiotics affect remission?
Limited and low quality evidence suggests that the route of antibiotic administration (oral versus parenteral) does not affect the rate of disease remission if the bacteria are susceptible to the antibiotic used. However, this and the lack of statistically significant differences in adverse effects ….
How long should antimicrobial therapy be for osteomyelitis?
Consensus recommendations for duration of curative antimicrobial therapy for most patients with osteomyelitis who have received “stage-appropriate” surgical interventions remain a minimum of 4 to 6 weeks.1,5Patients with more extensive infections and limited surgery may require more prolonged treatment; those with Cierney type 2 disease and adequate surgery may only require 2 weeks of treatment. In practice, clinicians often adopt a “goal-directed” approach to treatment duration, using clinical assessment and normalization of inflammatory markers (C-reactive protein and/or sedimentation rates) to define duration of therapy. Inflammatory markers have been proved useful in managing acute hematogenous pediatric osteomyelitis and in one recent study correlated with success of therapy in pyogenic vertebral osteomyelitis, but their role in determining duration of therapy in adults has not been thoroughly evaluated.16,17
What is the best antibiotic for methicillin resistant Staphylococcus aureus?
Beta-lactam antimicrobials remain the drugs of choice for nonallergic patients with methicillin-susceptible Staphylococcus aureus(MSSA) infections.1Less than 5% of S. aureusis still susceptible to penicillin; for such strains, intravenous penicillin G is used at doses of 3 to 4 million units every 4 to 6 hours. For other MSSA, the penicillinase-resistant penicillin drugs (oxacillin, nafcillin, flucloxacin) given intravenously have traditionally been considered the drugs of choice.1The first-generation cephalosporin cefazolin allows more convenient every-8-hour dosing and may have a better safety profile with lower rates of neutropenia and hypersensitivity and has been found equivalent to nafcillin or oxacillin in a retrospective study.10Dosing for bone infection is 2 g every 8 hours in adults with normal renal function. Broad spectrum third- and fourth-generation cephalosporins have also been used for MSSA infections, due to their more convenient dosing schedules, though this must be weighed against the impact of their broader spectrum of action and suppression of normal host bacterial flora and impact on resistance. Ceftriaxone is particularly attractive due to its once-daily dosing schedule, although the MICs of ceftriaxone against MSSA are generally higher than those of cefazolin, raising concern for potential treatment failure. Two retrospective studies showed no difference in relapse rates for ceftriaxone or cefazolin therapy in patients with S. aureusosteomyelitis.10,20Serum levels of parenteral β-lactams exceed the MIC of susceptible MSSA throughout most of the dosing interval. Such levels cannot reliably be achieved with oral regimens, due to their more limited oral bioavailability. Bone levels, typically 10 to 20% of serum levels, are even less likely to remain above the MIC. Thus, parenteral therapy is almost always preferred for curative β-lactam regimens.1One exception to this is acute pediatric osteomyelitis, where oral “step-down” therapy with β-lactam agents has been successfully used after an initial 1- to 2-week course of parenteral therapy.21,22There is less data supporting use of oral β-lactam therapy in adults.
What is daptomycin used for?
Daptomycin is a novel, parenteral cyclic lipopeptide with a unique bactericidal mechanism of action against gram-positive pathogens.43Daptomycin was noninferior to vancomycin for treatment of skin and soft tissue infections and for S. aureusand MRSA bacteremia. The approved dose for S. aureusbacteremia is 6 mg/kg every 24 hours. There is limited data on human daptomycin bone levels. Clinical experience with 67 osteomyelitis patients from a registry of patients receiving daptomycin was recently published.44Sixty-three percent were cured and 19% improved in this heterogeneous group of patients, most of whom had MRSA infections. Predominant toxicity is to skeletal muscle, and creatine phosphokinase should be monitored.
What is the best treatment for S. aureus?
Minocycline is extensively used as an oral option for community-acquired MRSA soft tissue infections. A recent review of clinical experience with tetracyclines for MRSA infections found few published reports of osteomyelitis treated with minocycline.38Several newer agents with good in vitro and in vivo activity against MRSA have recently been introduced. These include linezolid , daptomycin, and tigecycline. The optimal use of these agents and their role in treatment of acute and chronic osteomyelitis and comparative activity to intravenous vancomycin are still being evaluated. The best studied of these is linezolid, a bacteriostatic, protein synthesis inhibitor of the novel oxazolidinone class. Linezolid is active against S. aureusincluding nearly all MRSA strains, though resistance can very infrequently develop on therapy. Linezolid has nearly 100% oral bioavailability and demonstrates good bone penetration, with bone levels in healthy adults undergoing hip replacement surgery of 50% of serum levels.39Linezolid has demonstrated success rates comparable with or superior to those of vancomycin in clinical trials of skin and soft tissue infections and comparable with those of ampicillin-sulbactam for diabetic foot infections. Published experience with linezolid for osteomyelitis was recently reviewed by Falagas and colleagues, including case reports, analysis of data from the linezolid compassionate-use program, and several small prospective case series7,40,41,42Successful outcomes or cure were reported in 55 to 100% of published cases.41Toxicities of linezolid after more than 2 weeks include anemia and thrombocytopenia, thus hematologic parameters must be monitored, although in one small trial, rates were similar for vancomycin and linezolid therapy.42Other serious toxicities reported with prolonged linezolid therapy include lactic acidosis syndromes, optic neuritis, and peripheral neuropathy7,41In one study, 80% of 66 patients with chronic S. aureusosteomyelitis were cured after prolonged courses of linezolid (mean 13 weeks), but treatment-limiting toxicities occurred in one third of patients.7Thus, linezolid is not an ideal agent for very prolonged treatment courses or chronic suppressive therapy.
What animal model is used for osteomyelitis?
Much of the current approach to osteomyelitis is based on animal infection models. The most widely employed are variations of the rabbit Staphylococcus aureusmodel developed by Norden and colleagues in the late 1960s.11More recently developed sheep, goat, and dog large-animal models permit manipulation of surgical parameters as well as evaluation of antimicrobial therapy.12,13Animal models have contributed to understanding of revascularization and bone remodeling that occur after infection and debridement and have demonstrated effectiveness of agents such as clindamycin and rifampin-containing combinations in S. aureusinfections.11,12However, some drugs are toxic in animal models, and for others there is poor correlation between animal data and clinical experience. For example, vancomycin fared poorly in the rabbit models but has been used successfully in many human infections.12
Why is antimicrobial therapy important?
The goal of administering antimicrobial therapy is to optimize antimicrobial activity at the site of infection. Generally, this also correlates with achievable serum levels of drug, though there are some exceptions where volume of distribution of a drug is large and drug concentrations in tissues may exceed achievable serum levels. The route of administration is much less important than whether desired blood and tissue levels can be achieved, thus drugs with good to excellent oral bioavailability such as fluoroquinolones and linezolid can be given orally or enterally in patients with functional gastrointestinal tracts.7,8Several studies have demonstrated equivalence of appropriately chosen oral agents compared with parenteral therapy.8,9For the patient, oral therapy has advantages of simplicity and convenience, especially for prolonged treatment regimens, and avoids the risks of intravenous catheters and the generally higher costs associated with long-term parenteral therapy. For some agents with both oral and parenteral formulations, especially penicillins and cephalosporins, parenteral therapy provides much higher serum levels, or may be better tolerated than the high oral doses necessary to achieve target serum levels. Many important antimicrobials, including broad-spectrum cephalosporins, vancomycin, aminoglycosides, and carbapenems, can only be delivered intravenously. Agents with parenteral and oral bioequivalence are listed in Table Table1.1. A major evolution in health care has been improvement in delivery of long-term parenteral antimicrobial therapy.10The availability of long-term intravenous access options such as peripherally inserted central catheters has simplified the process of antibiotic delivery. The proliferation of outpatient infusion services now permits patients to receive appropriately monitored treatment at home or at infusion centers rather than in acute- or intermediate-care hospitals. Insurance and social issues may still be barriers to arranging outpatient intravenous therapy. Therapy of bone and joint infection is the second most common indication for outpatient intravenous antimicrobial therapy.10In addition to the primary considerations of spectrum of action and toxicity for choosing antimicrobial agents, other factors such as drug costs and convenience of the treatment regimen (e.g., dosing frequency, need for laboratory monitoring) must be considered.
What is the most important parameter in selecting an antimicrobial agent for treatment of bone infection?
The single most important parameter in selecting an antimicrobial agent for treatment of bone infection is its spectrum of activity —is the drug active against the targeted pathogen? Standard susceptibility tests provide in vitro data to assess a particular “drug-bug” combination, and generally lack of susceptibility in vitro correlates with clinical failure. However, susceptibility as determined by minimal inhibitory concentration (MIC) or disk diffusion testing does not necessarily predict clinical success. Susceptibility interpretations are based on achievable serum levels, and these may differ significantly from levels achievable in bone in surrounding tissue. In healthy bone specimens removed at surgery, levels of cefazolin and other cephalosporins may range from 10 to 20% of serum levels,1and levels may be even lower in diseased tissues with poor vascular perfusion. Drugs also differ in ability to penetrate biofilms or function in the specific pH and oxidative microenvironment where infection occurs. Infecting organisms, especially those in more chronic infections, may also be slowly replicating or in near-stationary growth phase and thus less responsive to many classes of antimicrobial agents. Much information regarding activity of different agents has been extrapolated from well-established animal models, but there remains a paucity of published clinical experience in humans with many of the newer antimicrobial agents and even some of the older drugs.3,4,5The mechanism of activity of an antimicrobial agent and whether it is bactericidal (lethal) or bacteriostatic (inhibitory) in vitro is not as important for successful treatment of osteomyelitis as it is for other difficult-to-eradicate infections such as bacterial endocarditis. However, the pharmacodynamic properties (i.e., the relationship between drug concentration and activity against the target organism over time) of an antibiotic and the relative ease of selection of antimicrobial-resistant mutants for different agents are theoretical parameters that may be important in antibiotic selection.6
How to treat osteomyelitis?
The most common treatments for osteomyelitis are surgery to remove portions of bone that are infected or dead, followed by intravenous antibiotics given in the hospital.
What does it mean when your blood test shows you have osteomyelitis?
Blood tests may reveal elevated levels of white blood cells and other factors that may indicate that your body is fighting an infection. If osteomyelitis is caused by an infection in the blood, tests may reveal which germs are to blame.
What is the procedure called when you remove diseased bone?
Remove diseased bone and tissue. In a procedure called debridement, the surgeon removes as much of the diseased bone as possible and takes a small margin of healthy bone to ensure that all the infected areas have been removed. Surrounding tissue that shows signs of infection also may be removed.
How long does it take for a bone biopsy to show infection?
The antibiotics are usually administered through a vein in your arm for about six weeks.
Which immune system is more likely to develop osteomyelitis?
Individuals with weakened immune systems are more likely to develop osteomyelitis. This includes people with sickle cell disease or HIV or those receiving immunosuppressive medications like chemotherapy or steroids.
How long does osteomyelitis last?
Intravenous or oral antibiotic treatment for osteomyelitis may be very extensive, lasting for many weeks.
What tests are done to check for osteomyelitis in children?
The provider treating your child will first do a thorough history and physical exam that may indicate signs of osteomyelitis like those listed above. An additional workup generally includes blood tests that look at white blood cells as well as markers for inflammation that are usually elevated during an infection.
What is the term for inflammation of the bone?
Osteomyelitis is inflammation or swelling that occurs in the bone. It can result from an infection somewhere else in the body that has spread to the bone, or it can start in the bone — often as a result of an injury. Osteomyelitis is more common in younger children (five and under) but can happen at any age. Boys are usually more affected ...
What are the long term complications of osteomyelitis?
Osteomyelitis requires long-term care to prevent further complications, including care to prevent the following: Fractures of the affected bone. Stunted growth in children (if the infection has involved the growth plate) Gangrene infection in the affected area.
How do you know if you have osteomyelitis?
The following are the most common symptoms of osteomyelitis; however, each individual may experience symptoms differently: Fever (may be high when osteomyelitis occurs as the result of a blood infection) Pain and tenderness in the affected area. Irritability in infants who can’t express pain. Feeling ill.
Can osteomyelitis be a medical condition?
The symptoms of osteomyelitis may resemble other medical conditions or problems. Always consult your doctor for a diagnosis.
What are the most common pathogens in osteomyelitis?
Group A streptococcus, Streptococcus pneumoniae, and Kingella kingae are the next most common pathogens in children.
Why is osteomyelitis a bacteremic disease?
Acute hematogenous osteomyelitis results from bacteremic seeding of bone. Children are most often affected because the metaphyseal (growing) regions of the long bones are highly vascular and susceptible to even minor trauma.
How long does it take for osteomyelitis to recur?
In adults, the duration of antibiotic treatment for chronic osteomyelitis is typically several weeks longer.
How to diagnose osteomyelitis in children?
Acute osteomyelitis in children is primarily a clinical diagnosis based on the rapid onset and localization of symptoms. Systemic symptoms such as fever, lethargy, and irritability may be present. The physical examination should focus on identifying common findings, such as erythema, soft tissue swelling or joint effusion, decreased joint range of motion, and bony tenderness. The identification of a bacterial infection may be difficult because blood cultures are positive in only about one-half of cases. 15 Because of the difficulty of diagnosis, the potential severity of infection in children, the high disease recurrence rate in adults, and the possible need for surgical intervention, consultation with an infectious disease subspecialist and an orthopedic subspecialist or plastic surgeon is advised. 16
What is the best diagnostic test for osteomyelitis?
The preferred diagnostic criterion for osteomyelitis is a positive bacterial culture from bone biopsy in the setting of bone necrosis.
Why is osteomyelitis more common in diabetics?
Chronic osteomyelitis from contiguous soft tissue infection is becoming more common because of the increasing prevalence of diabetic foot infections and peripheral vascular disease. Up to one-half of patients with diabetes develop peripheral neuropathy, which may reduce their awareness of wounds and increase the risk of unrecognized infections. 13 Peripheral vascular disease, which is also common in patients with diabetes, reduces the body's healing response and contributes to chronically open wounds and subsequent soft tissue infection. These conditions may act synergistically to significantly increase the risk of osteomyelitis in these patients. 14
How long does it take for osteomyelitis to show symptoms?
Acute osteomyelitis is associated with inflammatory bone changes caused by pathogenic bacteria, and symptoms typically present within two weeks after infection.
How many participants were in the osteomyelitis trial?
We included eight small trials involving a total of 282 participants with chronic osteomyelitis. Data were available from 248 participants. Most participants were male with post-traumatic osteomyelitis, usually affecting the tibia and femur, where recorded. The antibiotic regimens, duration of treatment and follow-up varied between trials. All trials mentioned surgical debridement before starting on antibiotic therapy as part of treatment, but it was unclear in four trials whether all participants underwent surgical debridement.
How many people were involved in the trial of osteomyelitis?
We included eight small randomised trials involving 282 people. The trials presented results for a total of 248 people with chronic osteomyelitis. Post-traumatic bone infections were the most frequent type. Surgical removal of the infected tissue (debridement) before starting on antibiotic therapy was mentioned as part of treatment in all trials, but in four trials it was unclear whether all participants underwent surgery. There were five comparisons of different treatments but we could only pool results for the comparison of antibiotic given by mouth with antibiotic given parenterally.
How long does osteomyelitis last?
Despite advances in both antibiotic and surgical treatment, the long-term recurrence rate remains around 20%.
What is the term for a chronic infection of the bone and bone marrow?
Antibiotics for treating chronic bone infection in adults. Osteomyelitis is an inflammation of the bone and bone marrow caused by pus-forming bacteria, mycobacteria or fungi. All bone infection that is long-standing is called chronic osteomyelitis.
Can you have surgical debridement before antibiotics?
All trials mentioned surgical debridement before starting on antibiotic therapy as part of treatment, but it was unclear in four trials whether all participants underwent surgical debridement.
Does oral antibiotic therapy affect osteomyelitis?
However, this and the lack of statistically significant differences in adverse effects need confirmation. No or insufficient evidence exists for other aspects of antibiotic therapy for chronic osteomyelitis.
Does antibiotic treatment affect remission?
This evidence suggests that the way antibiotics are given does not impact on the disease remission rate if the bacteria causing the infection are sensitive to the antibiotic used. However, confirmation is needed. There was either no or insufficient evidence on which to base judgements about the optimum length of antibiotic treatment or ...