musculoskeletal and connective tissue disorders
Osteomyelitis
Treatment of Osteomyelitis
Antibiotics Surgery for abscess, constitutional symptoms, potential spinal instability, or much necrotic bone Antibiotics effective against both gram-positive and gram-negative organisms are given after cultures have been done and until culture results and sensitivities are available. Foracute hematogenous osteomyelitis,initial antibiotic treatment should include a penicillinase-resistant semisynthetic penicillin (eg,nafcillinoroxacillin2 g IV every 4 hours) orvancomycin1 g IV every 12 hours (when MRSA is prevalent in a community, which is common) and a 3rd- or 4th-generation cephalosporin (such asceftazidime2 g IV every 8 hours orcefepime2 g IV every 12 hours). Forchronic osteomyelitisarising from a contiguous soft-tissue focus, particularly in patients with diabetes, empiric treatment must be effective against anaerobic organisms in addition to gram-positive and gram-negative aerobes.Ampicillin/sulbactam3 g IV every 6 hours orpiperacillin/tazobactam3.375 g IV every 6 hours is commonly used;vancomycin1 g IV every 12 hours is added when infection is severe or MRSA is prevalent. Antibiotics must be given parenterally for 4 to 8 weeks and tailored to results of appropriate cultures. If any constitutional findings (eg, fever, malaise, weight loss) persist or if large areas of bone are destroyed, necrotic tissue is debrided surgically. Surgery may also be needed to drain coexisting paravertebral or epidural abscesses or to stabilize the spine to prevent injury. Skin or pedicle grafts may be needed to close large surgical defects. Broad-spectrum antibiotics should be continued for>3 weeks after surgery. Long-term antibiotic therapy may be needed. 