Treatment and Prevention
Treatment of osteomyelitis depends on how the infection has spread to the bone and how deeply it has penetrated. If the bone infection has come through the blood and is a recent infection, treatment with oral antibiotic medications in high doses usually works. You'll be prescribed oral antibiotics against Staphylococcus aureus (such as cloxacillin* or clindamycin) unless your doctor has identified another type of bacteria responsible for the infection.
Because of the increasing frequency of bacteria becoming resistant to commonly used antibiotics, your doctor may take a sample from the infection to create a culture (letting the bacteria from the infection grow in the lab). The culture of the infection is essential in choosing the antibiotic most likely to work.
If a fungal infection is suspected as the cause for the osteomyelitis, then an antifungal medication may be prescribed.
If the osteomyelitis is very severe, you might need to take intravenous antibiotics at first and then switch to oral antibiotic pills later, once the infection is under control. People usually take them for 4 to 6 weeks, except for recurrent infections or infections of the spinal vertebrae, which need a 6- to 8-week treatment.
For serious infections, the buildup of pus may need to be drained by surgery. If the infection has spread from surrounding soft tissue, the dead tissue and bone is removed by surgery, and the space is filled with healthy bone, muscle, or skin by grafting before antibiotics are given.
If an artificial joint is infected, it has to be surgically removed and replaced. Antibiotics are usually given before and after surgery. In rare cases, the infection may not be cured and the infected limb may need to be amputated or the joint fused with surgery.
Sometimes foot ulcers (infections caused by poor circulation) due to diabetes can spread to the bones of the feet. These infections are often difficult to cure with antibiotics alone, and sometimes the infected bone must be surgically removed. This is one of the reasons people with diabetes should learn to take care of their feet and to follow the diet and treatment plans to get their blood sugar to within normal ranges. Ulcers and osteomyelitis may not heal if diabetes is not controlled, which can lead to amputations.
*All medications have both common (generic) and brand names. The brand name is what a specific manufacturer calls the product (e.g., Tylenol®). The common name is the medical name for the medication (e.g., acetaminophen). A medication may have many brand names, but only one common name. This article lists medications by their common names. For more information on brand names, speak with your doctor or pharmacist.
Michael E. Makover, MD, is a professor of medicine at NYU School of Medicine and an Adjunct Professor at NYU College of Arts and Sciences. He is in the private practice of Rheumatology, Internal Medicine and Preventive Medicine in New York, NY. Review provided by VeriMed Healthcare Network.