Osteomyelitis management

Question 1

What is the initial treatment for acute osteomyelitis?

Answer 1

The initial treatment for acute osteomyelitis is high-dose IV empirical antibiotics, usually for 2-4 weeks.

Question 2

When can patients with acute osteomyelitis be switched to oral antibiotics?

Answer 2

Patients with acute osteomyelitis can be switched to oral antibiotics once they have demonstrated clinical recovery and acute-phase reactants have returned to normal.

Question 3

What should be done before starting antibiotics for acute osteomyelitis?

Answer 3

Blood cultures should be taken before starting antibiotics for acute osteomyelitis.

Question 4

How should the antibiotic regimen be adjusted for acute osteomyelitis?

Answer 4

The antibiotic regimen should be altered once the results of microbiological culture and sensitivity (MC&S) tests arrive.

Question 5

What is the consideration for children with acute osteomyelitis who respond well to initial treatment?

Answer 5

In children who respond well to initial treatment, an early transition to oral antibiotics (after 3 days to 1 week) may be considered, followed by a 6-week course of oral antibiotics.

Question 6

What supportive measures should be taken for affected limbs in acute osteomyelitis?

Answer 6

Affected limbs should be immobilised, analgesia should be given, and associated comorbidities should be addressed.

Question 7

When might surgical debridement be necessary in acute osteomyelitis?

Answer 7

Surgical debridement may be necessary if there is dead bone or a biofilm in acute osteomyelitis.

Question 8

What are the key steps in managing chronic osteomyelitis?

Answer 8

The key steps in managing chronic osteomyelitis include clinical assessment, disease staging, and optimisation of comorbidities.

Question 9

What classification is used for disease staging in chronic osteomyelitis?

Answer 9

The Cierny-Mader classification is used for disease staging in chronic osteomyelitis.

Question 10

What are the treatment components for chronic osteomyelitis?

Answer 10

Treatment components for chronic osteomyelitis include surgical debridement, IV antibiotics, and functional rehabilitation.

Question 11

Osteomyeltis summary

Answer 11

Osteomyelitis
 Acute Osteomyelitis
o High-dose IV empirical antibiotics (usually for 2-4 weeks)
o Once the patient has demonstrated clinical recovery and acute-phase reactants have
returned to normal, patients can be switched to oral antibiotics
o IMPORTANT: take blood cultures before starting antibiotics
o The regimen should be altered once results of MC&S arrive
o NOTE: in children who respond well, early transition to oral antibiotics (after 3 days to
1 week) may be considered
 6-week course of oral antibiotics
o Affected limbs should be immobilised, analgesia should be given, and associated comorbidities should be addressed
o Surgical debridement may be necessary if there is dead bone or a biofilm  Chronic Osteomyelitis
o Clinical assessment, disease staging (Cierny-Mader classification) and optimisation of comorbidities
o Surgical debridement
o IV antibiotics
o Functional rehabilitation