Materiały źródłowe

• #1 Osteomyelitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK532250/

  Osteomyelitis is a serious infection of the bone that can be either acute or chronic. […] This activity outlines the evaluation and management of osteomyelitis and explains the role of the interprofessional team in improving care for patients with this condition. […] Effective treatment of osteomyelitis involves a collaborative effort among various medical and surgical specialties. The two main aspects of therapy are surgical containment of the infection and prolonged antibiotics. Surgical debridement of all diseased bone is often required as antibiotics penetrate poorly into infected fluid collections such as abscesses and injured or necrotic bone. […] Prolonged antibiotic therapy is the cornerstone of treatment for osteomyelitis. […] The recommended duration of treatment for osteomyelitis in adults is 4 to 6 weeks of parenteral antibiotic therapy to achieve acceptable cure rates with a decreased risk of recurrence.

• #1 Osteomyelitis Treatment & Management: Approach Considerations, Medical Therapy, Surgical Therapy

  https://emedicine.medscape.com/article/1348767-treatment

  Antibiotic treatment should be based on the identification of pathogens from bone cultures at the time of bone biopsy or debridement. […] Prophylactic treatment with the bead pouch technique has been suggested in open fractures to reduce the risk of infection. Systemic antibiotics supplemented with antibiotic beads are preferred to systemic antibiotics alone. […] Traditionally, antibiotic treatment of osteomyelitis has consisted of a 4- to 6-week course. […] Oral antibiotics that have been proved to be effective include clindamycin, rifampin, trimethoprim-sulfamethoxazole, and fluoroquinolones. […] Empiric therapy is necessary when it is not possible to isolate organisms from the infection site. […] Suppressive antibiotic therapy should also be directed by bone culture and is given orally when surgery is contraindicated.

• #2 Osteomyelitis – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/osteomyelitis/symptoms-causes/syc-20375913

  Most people with osteomyelitis need surgery to remove areas of the affected bone. After surgery, most often people need strong antibiotics given through a vein. […] Osteomyelitis complications may include: Bone death, also called osteonecrosis. An infection in your bone can block blood flow within the bone, leading to bone death. If you have areas where bone has died, you need surgery to remove the dead tissue for antibiotics to work. […] If you have an increased risk of infection, talk with your healthcare professional about ways to prevent infections. Cutting your risk of infection will cut your risk of osteomyelitis.

• #2 Osteomyelitis: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2021/1000/p395.html

  The choice of antibiotic therapy is specific to the culture results. It should be tailored to the individual patient based on susceptibility. Specific antibiotic coverage is usually indicated. In hospitalized patients at risk of methicillin-resistant S. aureus, empiric antibiotic coverage is recommended. Delaying antibiotic therapy until cultures are available is recommended except in patients in whom urgent intervention is necessary, such as those with severe sepsis, epidural extension, or neurologic involvement. The addition of rifampin to other antibiotics may also improve cure rates, especially when prosthetic joint or spinal implant infections are present. For adult patients hospitalized with osteomyelitis, parenteral followed by oral antibiotic therapy appears to be as effective as long-term parenteral therapy. Evidence suggests that oral antibiotics have similar cure rates and lower risks and costs compared with parenteral antibiotics. Treatment typically lasts four to six weeks, but comparisons of treatment duration have not been well studied.

• #3 Osteomyelitis – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/3000178

  Osteomyelitis should be suspected in those with a history of open fracture, recent orthopaedic surgery, or a discharging sinus; in unwell children with a limp, or in immunocompromised patients. […] In chronic osteomyelitis, surgery to remove necrotic bone is the primary treatment. Antibiotics alone cannot achieve a cure. […] Aim to take microbiological samples before giving empirical antibiotics. However, if the patient is septic or otherwise unwell, sampling should not delay the administration of antibiotics. […] The diagnosis should be confirmed by culture obtained from biopsy of the involved bone. There is limited value in surface or sinus swabs. […] Magnetic resonance imaging (MRI) is the imaging modality with greatest sensitivity for diagnosing osteomyelitis.

• #4 Osteomyelitis Treatment & Management: Approach Considerations, Medical Therapy, Surgical Therapy

  https://emedicine.medscape.com/article/1348767-treatment

  Antibiotic treatment should be based on the identification of pathogens from bone cultures at the time of bone biopsy or debridement. […] Prophylactic treatment with the bead pouch technique has been suggested in open fractures to reduce the risk of infection. Systemic antibiotics supplemented with antibiotic beads are preferred to systemic antibiotics alone. […] Traditionally, antibiotic treatment of osteomyelitis has consisted of a 4- to 6-week course. […] Oral antibiotics that have been proved to be effective include clindamycin, rifampin, trimethoprim-sulfamethoxazole, and fluoroquinolones. […] Empiric therapy is necessary when it is not possible to isolate organisms from the infection site. […] Suppressive antibiotic therapy should also be directed by bone culture and is given orally when surgery is contraindicated.

• #5 Osteomyelitis (Bone Infection): Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/osteomyelitis-bone-infection

  Osteomyelitis is a serious infection that happens when bacteria or fungi infect your bone marrow. It can cause permanent bone damage if its not treated right away. […] Your provider will suggest treatments to kill the infection and prevent permanent bone damage. The most common osteomyelitis treatments include: […] Youll need antibiotics to cure a bacterial infection. You may need intravenous (IV) antibiotics for a few weeks before taking oral (pills you take by mouth) antibiotics for several weeks afterward. […] Antifungals treat fungal infections. Youll probably need oral antifungal medications for several months. […] You may need surgery if the bone infection is severe or you have a high risk of complications. […] Most people with osteomyelitis recover without long-term complications. But its important to get the infection diagnosed and start treatment right away.

• #6 Osteomyelitis

  https://www.nhs.uk/conditions/osteomyelitis/

  Osteomyelitis is treated with antibiotics. You may need treatment in hospital, or you might be able to take antibiotics at home. […] You’ll usually take antibiotics for 4 to 6 weeks. If you have a severe infection, you may need to take them for up to 12 weeks. It’s important to finish a course of antibiotics even if you start to feel better. […] If the infection is treated quickly (within 3 to 5 days of it starting), it often clears up completely. […] You’ll usually need an operation if: a build-up of pus (abscess) develops in the bone and the pus needs to be drained, the infection presses against something else, for example, the spinal cord, the infection has lasted a long time and damaged the bone. […] If the infection has damaged the bone, you’ll need surgery (known as debridement) to remove the damaged part. […] Sometimes more than 1 operation is needed to treat the infection. Muscle and skin from another part of the body might be used to repair the area near the affected bone.

• #7 Osteomyelitis: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2021/1000/p395.html

  The choice of antibiotic therapy is specific to the culture results. It should be tailored to the individual patient based on susceptibility. Specific antibiotic coverage is usually indicated. In hospitalized patients at risk of methicillin-resistant S. aureus, empiric antibiotic coverage is recommended. Delaying antibiotic therapy until cultures are available is recommended except in patients in whom urgent intervention is necessary, such as those with severe sepsis, epidural extension, or neurologic involvement. The addition of rifampin to other antibiotics may also improve cure rates, especially when prosthetic joint or spinal implant infections are present. For adult patients hospitalized with osteomyelitis, parenteral followed by oral antibiotic therapy appears to be as effective as long-term parenteral therapy. Evidence suggests that oral antibiotics have similar cure rates and lower risks and costs compared with parenteral antibiotics. Treatment typically lasts four to six weeks, but comparisons of treatment duration have not been well studied.

• #8 Systemic Antimicrobial Treatment of Chronic Osteomyelitis in Adults: A Narrative Review

  https://www.mdpi.com/2079-6382/12/6/944

  In all the identified RCTs, as well as meta-analyses in this review, conclusions indicated non-inferiority of short term versus long term therapy for osteomyelitis. However, the quality of evidence for this is low. There is inconsistency in the definitions of short-term and long-term antimicrobial therapy for chronic osteomyelitis, which contributes to the heterogeneity of the results and hinders the ability to draw firm conclusions. […] There has been growing interest in exploring the role of oral antibiotic therapy or short-term parenteral therapy followed by oral antibiotics as a potential outpatient management option for chronic osteomyelitis. Due to vascular impairment, it is a therapeutic challenge to deliver pharmaceutical agents to the site of osteitis. An oral approach may offer advantages in terms of reduced hospitalisation duration, improved patient convenience, and potentially lower healthcare costs, with no statistically significant cure rates between oral and parenteral therapy. However, the efficacy, safety, and optimal selection of patients for this approach compared to traditional parenteral antibiotic therapy require further investigation.

• #9 Recommendations for the treatment of osteomyelitis | The Brazilian Journal of Infectious Diseases

  https://www.bjid.org.br/en-recommendations-for-treatment-osteomyelitis-articulo-resumen-S1413867014000579

  With the advances in surgical treatment, antibiotic therapy and the current resources for accurate diagnosis and differentiated approaches to each type of osteomyelitis, better results are being obtained in the treatment of this disease. […] The objective of this review article is to indicate some recommendations based on scientific evidence that will guide the medical approach to different types of osteomyelitis, aiming to obtain better clinical outcomes and at reducing the social costs of this disease. […] The success of osteomyelitis treatment, particularly in cases related to implants, is closely linked to extensive surgical debridement and adequate antibiotic therapy. […] Acute infections can be treated initially with extensive surgical cleaning associated with antibiotic therapy lasting four to six weeks. Chronic infections should be treated with extensive surgical debridement, removal of any implants and antibiotic therapy lasting three to six months.

• #10 Diagnosis and Management of Osteomyelitis | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/1101/p1027.html

  Despite the use of surgical debridement and long-term antibiotic therapy, the recurrence rate of chronic osteomyelitis in adults is about 30 percent at 12 months. Recurrence rates in cases involving P. aeruginosa are even higher, nearing 50 percent. The optimal duration of antibiotic treatment and route of delivery are unclear. For chronic osteomyelitis, parenteral antibiotic therapy for two to six weeks is generally recommended, with a transition to oral antibiotics for a total treatment period of four to eight weeks. Long-term parenteral therapy is likely as effective as transitioning to oral medications, but has similar recurrence rates with increased adverse effects. In some cases, surgery is necessary to preserve viable tissue and prevent recurrent systemic infection. […] Antibiotic regimens for the empiric treatment of acute osteomyelitis, particularly in children, should include an agent directed against S. aureus. Betalactam antibiotics are first-line options unless MRSA is suspected. If methicillin resistance among community isolates of Staphylococcus is greater than 10 percent, MRSA should be considered in initial antibiotic coverage. Intravenous vancomycin is the first-line choice. In patients with diabetic foot infections or penicillin allergies, fluoroquinolones are an alternate option for staphylococcal infections; these agents seem to be as effective as beta-lactams.

• #11 Diagnosis and Management of Osteomyelitis | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/1101/p1027.html

  Despite the use of surgical debridement and long-term antibiotic therapy, the recurrence rate of chronic osteomyelitis in adults is about 30 percent at 12 months. Recurrence rates in cases involving P. aeruginosa are even higher, nearing 50 percent. The optimal duration of antibiotic treatment and route of delivery are unclear. For chronic osteomyelitis, parenteral antibiotic therapy for two to six weeks is generally recommended, with a transition to oral antibiotics for a total treatment period of four to eight weeks. Long-term parenteral therapy is likely as effective as transitioning to oral medications, but has similar recurrence rates with increased adverse effects. In some cases, surgery is necessary to preserve viable tissue and prevent recurrent systemic infection. […] Antibiotic regimens for the empiric treatment of acute osteomyelitis, particularly in children, should include an agent directed against S. aureus. Betalactam antibiotics are first-line options unless MRSA is suspected. If methicillin resistance among community isolates of Staphylococcus is greater than 10 percent, MRSA should be considered in initial antibiotic coverage. Intravenous vancomycin is the first-line choice. In patients with diabetic foot infections or penicillin allergies, fluoroquinolones are an alternate option for staphylococcal infections; these agents seem to be as effective as beta-lactams.

• #12 List of 55 Bone infection (Osteomyelitis) Medications Compared

  https://www.drugs.com/condition/osteomyelitis.html

  Osteomyelitis is an acute or chronic bone infection, usually caused by bacteria. […] The medications listed below are related to or used in the treatment of this condition. […] The drug class for cephalexin is first generation cephalosporins. […] The drug class for clindamycin is lincomycin derivatives. […] The drug class for ciprofloxacin is quinolones and fluoroquinolones. […] The drug class for vancomycin is glycopeptide antibiotics. […] The drug class for ceftriaxone is third generation cephalosporins. […] The drug class for Zosyn is penicillins/beta-lactamase inhibitors. […] The drug class for cefazolin is first generation cephalosporins. […] The drug class for metronidazole is amebicides, miscellaneous antibiotics. […] The drug class for dicloxacillin is penicillinase resistant penicillins.

• #13 List of 55 Bone infection (Osteomyelitis) Medications Compared

  https://www.drugs.com/condition/osteomyelitis.html

  Osteomyelitis is an acute or chronic bone infection, usually caused by bacteria. […] The medications listed below are related to or used in the treatment of this condition. […] The drug class for cephalexin is first generation cephalosporins. […] The drug class for clindamycin is lincomycin derivatives. […] The drug class for ciprofloxacin is quinolones and fluoroquinolones. […] The drug class for vancomycin is glycopeptide antibiotics. […] The drug class for ceftriaxone is third generation cephalosporins. […] The drug class for Zosyn is penicillins/beta-lactamase inhibitors. […] The drug class for cefazolin is first generation cephalosporins. […] The drug class for metronidazole is amebicides, miscellaneous antibiotics. […] The drug class for dicloxacillin is penicillinase resistant penicillins.

• #14 List of 55 Bone infection (Osteomyelitis) Medications Compared

  https://www.drugs.com/condition/osteomyelitis.html

  Osteomyelitis is an acute or chronic bone infection, usually caused by bacteria. […] The medications listed below are related to or used in the treatment of this condition. […] The drug class for cephalexin is first generation cephalosporins. […] The drug class for clindamycin is lincomycin derivatives. […] The drug class for ciprofloxacin is quinolones and fluoroquinolones. […] The drug class for vancomycin is glycopeptide antibiotics. […] The drug class for ceftriaxone is third generation cephalosporins. […] The drug class for Zosyn is penicillins/beta-lactamase inhibitors. […] The drug class for cefazolin is first generation cephalosporins. […] The drug class for metronidazole is amebicides, miscellaneous antibiotics. […] The drug class for dicloxacillin is penicillinase resistant penicillins.

• #15 List of 55 Bone infection (Osteomyelitis) Medications Compared

  https://www.drugs.com/condition/osteomyelitis.html

  The drug class for piperacillin / tazobactam is penicillins/beta-lactamase inhibitors. […] The drug class for cefuroxime is second generation cephalosporins. […] The drug class for gentamicin is aminoglycosides. […] The drug class for cefotaxime is third generation cephalosporins. […] The drug class for ofloxacin is quinolones and fluoroquinolones. […] The drug class for ampicillin / sulbactam is penicillins/beta-lactamase inhibitors.

• #16 List of 55 Bone infection (Osteomyelitis) Medications Compared

  https://www.drugs.com/condition/osteomyelitis.html

  Osteomyelitis is an acute or chronic bone infection, usually caused by bacteria. […] The medications listed below are related to or used in the treatment of this condition. […] The drug class for cephalexin is first generation cephalosporins. […] The drug class for clindamycin is lincomycin derivatives. […] The drug class for ciprofloxacin is quinolones and fluoroquinolones. […] The drug class for vancomycin is glycopeptide antibiotics. […] The drug class for ceftriaxone is third generation cephalosporins. […] The drug class for Zosyn is penicillins/beta-lactamase inhibitors. […] The drug class for cefazolin is first generation cephalosporins. […] The drug class for metronidazole is amebicides, miscellaneous antibiotics. […] The drug class for dicloxacillin is penicillinase resistant penicillins.

• #17 List of 55 Bone infection (Osteomyelitis) Medications Compared

  https://www.drugs.com/condition/osteomyelitis.html

  Osteomyelitis is an acute or chronic bone infection, usually caused by bacteria. […] The medications listed below are related to or used in the treatment of this condition. […] The drug class for cephalexin is first generation cephalosporins. […] The drug class for clindamycin is lincomycin derivatives. […] The drug class for ciprofloxacin is quinolones and fluoroquinolones. […] The drug class for vancomycin is glycopeptide antibiotics. […] The drug class for ceftriaxone is third generation cephalosporins. […] The drug class for Zosyn is penicillins/beta-lactamase inhibitors. […] The drug class for cefazolin is first generation cephalosporins. […] The drug class for metronidazole is amebicides, miscellaneous antibiotics. […] The drug class for dicloxacillin is penicillinase resistant penicillins.

• #18 List of 55 Bone infection (Osteomyelitis) Medications Compared

  https://www.drugs.com/condition/osteomyelitis.html

  Osteomyelitis is an acute or chronic bone infection, usually caused by bacteria. […] The medications listed below are related to or used in the treatment of this condition. […] The drug class for cephalexin is first generation cephalosporins. […] The drug class for clindamycin is lincomycin derivatives. […] The drug class for ciprofloxacin is quinolones and fluoroquinolones. […] The drug class for vancomycin is glycopeptide antibiotics. […] The drug class for ceftriaxone is third generation cephalosporins. […] The drug class for Zosyn is penicillins/beta-lactamase inhibitors. […] The drug class for cefazolin is first generation cephalosporins. […] The drug class for metronidazole is amebicides, miscellaneous antibiotics. […] The drug class for dicloxacillin is penicillinase resistant penicillins.

• #19 List of 55 Bone infection (Osteomyelitis) Medications Compared

  https://www.drugs.com/condition/osteomyelitis.html

  The drug class for piperacillin / tazobactam is penicillins/beta-lactamase inhibitors. […] The drug class for cefuroxime is second generation cephalosporins. […] The drug class for gentamicin is aminoglycosides. […] The drug class for cefotaxime is third generation cephalosporins. […] The drug class for ofloxacin is quinolones and fluoroquinolones. […] The drug class for ampicillin / sulbactam is penicillins/beta-lactamase inhibitors.

• #20 Diagnosis and Management of Osteomyelitis | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/1101/p1027.html

  Despite the use of surgical debridement and long-term antibiotic therapy, the recurrence rate of chronic osteomyelitis in adults is about 30 percent at 12 months. Recurrence rates in cases involving P. aeruginosa are even higher, nearing 50 percent. The optimal duration of antibiotic treatment and route of delivery are unclear. For chronic osteomyelitis, parenteral antibiotic therapy for two to six weeks is generally recommended, with a transition to oral antibiotics for a total treatment period of four to eight weeks. Long-term parenteral therapy is likely as effective as transitioning to oral medications, but has similar recurrence rates with increased adverse effects. In some cases, surgery is necessary to preserve viable tissue and prevent recurrent systemic infection. […] Antibiotic regimens for the empiric treatment of acute osteomyelitis, particularly in children, should include an agent directed against S. aureus. Betalactam antibiotics are first-line options unless MRSA is suspected. If methicillin resistance among community isolates of Staphylococcus is greater than 10 percent, MRSA should be considered in initial antibiotic coverage. Intravenous vancomycin is the first-line choice. In patients with diabetic foot infections or penicillin allergies, fluoroquinolones are an alternate option for staphylococcal infections; these agents seem to be as effective as beta-lactams.

• #21 Osteomyelitis: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2021/1000/p395.html

  The choice of antibiotic therapy is specific to the culture results. It should be tailored to the individual patient based on susceptibility. Specific antibiotic coverage is usually indicated. In hospitalized patients at risk of methicillin-resistant S. aureus, empiric antibiotic coverage is recommended. Delaying antibiotic therapy until cultures are available is recommended except in patients in whom urgent intervention is necessary, such as those with severe sepsis, epidural extension, or neurologic involvement. The addition of rifampin to other antibiotics may also improve cure rates, especially when prosthetic joint or spinal implant infections are present. For adult patients hospitalized with osteomyelitis, parenteral followed by oral antibiotic therapy appears to be as effective as long-term parenteral therapy. Evidence suggests that oral antibiotics have similar cure rates and lower risks and costs compared with parenteral antibiotics. Treatment typically lasts four to six weeks, but comparisons of treatment duration have not been well studied.

• #22 Systemic Antimicrobial Treatment of Chronic Osteomyelitis in Adults: A Narrative Review

  https://www.mdpi.com/2079-6382/12/6/944

  Combination antibiotic therapy with rifampicin has been proposed as an adjunctive treatment option for chronic osteomyelitis due to its potent activity against biofilm-forming bacteria, which are known to be a key factor in the pathogenesis of chronic osteomyelitis. The addition of rifampicin to the antibiotic regimen may improve the clinical outcomes and reduce the risk of treatment failure. However, the optimal duration and selection of patients for this approach remain uncertain, and the potential for rifampicin-associated adverse effects, including drug interactions and development of rifampicin resistance, needs to be carefully considered. […] The available evidence from RCTs and meta-analyses seems to indicate non-inferiority of short-term versus long-term antimicrobial therapy for osteomyelitis. Evidence is however limited and suggests that shorter-term therapy may only be sufficient for low-risk patients, whereas high-risk patients require at least 6 weeks of antibiotic therapy. Adverse effects were found to be more common with long-term therapy.

• #23 Osteomyelitis (Bone Infection): Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/osteomyelitis-bone-infection

  Osteomyelitis is a serious infection that happens when bacteria or fungi infect your bone marrow. It can cause permanent bone damage if its not treated right away. […] Your provider will suggest treatments to kill the infection and prevent permanent bone damage. The most common osteomyelitis treatments include: […] Youll need antibiotics to cure a bacterial infection. You may need intravenous (IV) antibiotics for a few weeks before taking oral (pills you take by mouth) antibiotics for several weeks afterward. […] Antifungals treat fungal infections. Youll probably need oral antifungal medications for several months. […] You may need surgery if the bone infection is severe or you have a high risk of complications. […] Most people with osteomyelitis recover without long-term complications. But its important to get the infection diagnosed and start treatment right away.

• #24 Osteomyelitis: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2021/1000/p395.html

  Surgical bony debridement followed by drainage of any associated soft tissue abscess continues to be a mainstay of therapy, although there is no clear recommendation about which cases will require debridement. Debridement is typically indicated as part of the initial treatment in the presence of underlying orthopedic hardware and necrotic bone. Stabilization of the bone is an essential component of debridement and can decrease healing time and complications. Surgical debridement after antibiotic therapy shortens hospital stays, reduces medical costs, provides satisfactory infection control, and prevents complications of long-term systemic antibiotic use. Debridement can be supplemented with the placement of antibiotic-loaded collagen sponges, which has some evidence supporting improved outcomes. Hyperbaric oxygen therapy can be used as an adjunctive modality and may be particularly helpful in cases of chronic osteomyelitis.

• #25 Osteomyelitis: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2021/1000/p395.html

  Surgical bony debridement followed by drainage of any associated soft tissue abscess continues to be a mainstay of therapy, although there is no clear recommendation about which cases will require debridement. Debridement is typically indicated as part of the initial treatment in the presence of underlying orthopedic hardware and necrotic bone. Stabilization of the bone is an essential component of debridement and can decrease healing time and complications. Surgical debridement after antibiotic therapy shortens hospital stays, reduces medical costs, provides satisfactory infection control, and prevents complications of long-term systemic antibiotic use. Debridement can be supplemented with the placement of antibiotic-loaded collagen sponges, which has some evidence supporting improved outcomes. Hyperbaric oxygen therapy can be used as an adjunctive modality and may be particularly helpful in cases of chronic osteomyelitis.

• #26 Osteomyelitis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/osteomyelitis/diagnosis-treatment/drc-20375917

  Most often, treatment for osteomyelitis involves surgery to remove parts of the bone that are infected or dead. Then you get antibiotics through a vein, called intravenous antibiotics. […] Depending on how bad the infection is, osteomyelitis surgery may involve one or more of the following procedures: […] A surgeon opens the area around the infected bone to drain pus or fluid from the infection. […] In a procedure called debridement, the surgeon removes as much of the diseased bone as possible. The surgeon also may remove a small amount of healthy bone and tissue around the diseased bone. This is a way to make sure to remove all the infection. […] The surgeon may fill any empty space the debridement procedure leaves with a piece of bone or other tissue. This might be skin or muscle from another part of the body. […] Your healthcare professional chooses an antibiotic based on the germ causing the infection. You are likely to get the antibiotic through a vein in your arm for about six weeks. If your infection is more serious, you may then need to take antibiotics by mouth.

• #27 Osteomyelitis | Cooper University Health Care

  https://www.cooperhealth.org/services/osteomyelitis

  Drainage: Your surgeon will open up the area around the infected bone and drain any fluid that has accumulated due to the infection […] Debridement: This is a surgical procedure in which the surgeon removes as much of the diseased bone as possible. Any surrounding tissue that shows signs of infection may also be removed. […] Bone or tissue graft: This helps to restore blood flow to the bone. It involves filling any space left by debridement with a piece of bone or tissue from another part of your body; this graft helps your body repair damaged blood vessels and grow new bone. […] Removal of previous surgical fixation devices: Sometimes, surgical plates, pins or screws placed during a previous surgery must be removed […] Limb amputation: In severe cases, amputation may be necessary to prevent your infection from spreading further.

• #28 Osteomyelitis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/osteomyelitis/diagnosis-treatment/drc-20375917

  Most often, treatment for osteomyelitis involves surgery to remove parts of the bone that are infected or dead. Then you get antibiotics through a vein, called intravenous antibiotics. […] Depending on how bad the infection is, osteomyelitis surgery may involve one or more of the following procedures: […] A surgeon opens the area around the infected bone to drain pus or fluid from the infection. […] In a procedure called debridement, the surgeon removes as much of the diseased bone as possible. The surgeon also may remove a small amount of healthy bone and tissue around the diseased bone. This is a way to make sure to remove all the infection. […] The surgeon may fill any empty space the debridement procedure leaves with a piece of bone or other tissue. This might be skin or muscle from another part of the body. […] Your healthcare professional chooses an antibiotic based on the germ causing the infection. You are likely to get the antibiotic through a vein in your arm for about six weeks. If your infection is more serious, you may then need to take antibiotics by mouth.

• #29 Osteomyelitis Treatment & Management: Approach Considerations, Medical Therapy, Surgical Therapy

  https://emedicine.medscape.com/article/1348767-treatment

  The Ilizarov technique is usually well tolerated by the patient, with little associated pain. […] Operative treatment consists of the following: Adequate drainage, Extensive debridement of necrotic tissue, Management of dead space, Adequate soft-tissue coverage, Restoration of blood supply. […] Remission or cure is most likely with extensive debridement, obliteration of dead space, removal of any hardware, and appropriate antibiotic therapy. […] Dead space must be filled with durable vascularized tissue, sometimes from the fibula or ilium. Antibiotic-impregnated beads may be used for temporary sterilization of dead space. […] Given that a central tenet in surgical management of osteomyelitis involves filling in the dead space with viable vascularized tissue, it is not surprising that various ways of filling the defect and maximizing local antibiotic delivery have been engineered.

• #30 Osteomyelitis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/osteomyelitis/diagnosis-treatment/drc-20375917

  Most often, treatment for osteomyelitis involves surgery to remove parts of the bone that are infected or dead. Then you get antibiotics through a vein, called intravenous antibiotics. […] Depending on how bad the infection is, osteomyelitis surgery may involve one or more of the following procedures: […] A surgeon opens the area around the infected bone to drain pus or fluid from the infection. […] In a procedure called debridement, the surgeon removes as much of the diseased bone as possible. The surgeon also may remove a small amount of healthy bone and tissue around the diseased bone. This is a way to make sure to remove all the infection. […] The surgeon may fill any empty space the debridement procedure leaves with a piece of bone or other tissue. This might be skin or muscle from another part of the body. […] Your healthcare professional chooses an antibiotic based on the germ causing the infection. You are likely to get the antibiotic through a vein in your arm for about six weeks. If your infection is more serious, you may then need to take antibiotics by mouth.

• #31 Osteomyelitis Treatment & Management: Approach Considerations, Medical Therapy, Surgical Therapy

  https://emedicine.medscape.com/article/1348767-treatment

  The Ilizarov technique is usually well tolerated by the patient, with little associated pain. […] Operative treatment consists of the following: Adequate drainage, Extensive debridement of necrotic tissue, Management of dead space, Adequate soft-tissue coverage, Restoration of blood supply. […] Remission or cure is most likely with extensive debridement, obliteration of dead space, removal of any hardware, and appropriate antibiotic therapy. […] Dead space must be filled with durable vascularized tissue, sometimes from the fibula or ilium. Antibiotic-impregnated beads may be used for temporary sterilization of dead space. […] Given that a central tenet in surgical management of osteomyelitis involves filling in the dead space with viable vascularized tissue, it is not surprising that various ways of filling the defect and maximizing local antibiotic delivery have been engineered.

• #32 Osteomyelitis: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2021/1000/p395.html

  Surgical bony debridement followed by drainage of any associated soft tissue abscess continues to be a mainstay of therapy, although there is no clear recommendation about which cases will require debridement. Debridement is typically indicated as part of the initial treatment in the presence of underlying orthopedic hardware and necrotic bone. Stabilization of the bone is an essential component of debridement and can decrease healing time and complications. Surgical debridement after antibiotic therapy shortens hospital stays, reduces medical costs, provides satisfactory infection control, and prevents complications of long-term systemic antibiotic use. Debridement can be supplemented with the placement of antibiotic-loaded collagen sponges, which has some evidence supporting improved outcomes. Hyperbaric oxygen therapy can be used as an adjunctive modality and may be particularly helpful in cases of chronic osteomyelitis.

• #33 Osteomyelitis: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/000437.htm

  The goal of treatment is to get rid of the infection and reduce damage to the bone and surrounding tissues. […] Antibiotics are given to destroy the bacteria causing the infection: […] You may receive more than one antibiotic at a time. […] Antibiotics are taken for at least 4 to 6 weeks, often at home through an IV (intravenously, meaning through a vein). […] Surgery may be needed to remove dead bone tissue if the above methods fail: […] If there are metal plates near the infection, they may need to be removed. […] The open space left by the removed bone tissue may be filled with bone graft or packing material. This promotes resolution of the infection. […] Infection that occurs after joint replacement may require surgery. This is done to remove the replaced joint and infected tissue in the area. A new prosthesis may be implanted in the same operation. More often, providers wait until the antibiotic course is finished and the infection has gone away. […] If you have diabetes, it will need to be well controlled. If there are problems with blood supply to the infected area, such as the foot, surgery may be needed to improve blood flow in order to get rid of the infection.

• #34 Recommendations for the treatment of osteomyelitis | The Brazilian Journal of Infectious Diseases

  https://www.bjid.org.br/en-recommendations-for-treatment-osteomyelitis-articulo-resumen-S1413867014000579

  With the advances in surgical treatment, antibiotic therapy and the current resources for accurate diagnosis and differentiated approaches to each type of osteomyelitis, better results are being obtained in the treatment of this disease. […] The objective of this review article is to indicate some recommendations based on scientific evidence that will guide the medical approach to different types of osteomyelitis, aiming to obtain better clinical outcomes and at reducing the social costs of this disease. […] The success of osteomyelitis treatment, particularly in cases related to implants, is closely linked to extensive surgical debridement and adequate antibiotic therapy. […] Acute infections can be treated initially with extensive surgical cleaning associated with antibiotic therapy lasting four to six weeks. Chronic infections should be treated with extensive surgical debridement, removal of any implants and antibiotic therapy lasting three to six months.

• #35 Osteomyelitis – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/3000178

  Osteomyelitis should be suspected in those with a history of open fracture, recent orthopaedic surgery, or a discharging sinus; in unwell children with a limp, or in immunocompromised patients. […] In chronic osteomyelitis, surgery to remove necrotic bone is the primary treatment. Antibiotics alone cannot achieve a cure. […] Aim to take microbiological samples before giving empirical antibiotics. However, if the patient is septic or otherwise unwell, sampling should not delay the administration of antibiotics. […] The diagnosis should be confirmed by culture obtained from biopsy of the involved bone. There is limited value in surface or sinus swabs. […] Magnetic resonance imaging (MRI) is the imaging modality with greatest sensitivity for diagnosing osteomyelitis.

• #36 Osteomyelitis: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2021/1000/p395.html

  Surgical bony debridement followed by drainage of any associated soft tissue abscess continues to be a mainstay of therapy, although there is no clear recommendation about which cases will require debridement. Debridement is typically indicated as part of the initial treatment in the presence of underlying orthopedic hardware and necrotic bone. Stabilization of the bone is an essential component of debridement and can decrease healing time and complications. Surgical debridement after antibiotic therapy shortens hospital stays, reduces medical costs, provides satisfactory infection control, and prevents complications of long-term systemic antibiotic use. Debridement can be supplemented with the placement of antibiotic-loaded collagen sponges, which has some evidence supporting improved outcomes. Hyperbaric oxygen therapy can be used as an adjunctive modality and may be particularly helpful in cases of chronic osteomyelitis.

• #37 Osteomyelitis: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2021/1000/p395.html

  Surgical bony debridement followed by drainage of any associated soft tissue abscess continues to be a mainstay of therapy, although there is no clear recommendation about which cases will require debridement. Debridement is typically indicated as part of the initial treatment in the presence of underlying orthopedic hardware and necrotic bone. Stabilization of the bone is an essential component of debridement and can decrease healing time and complications. Surgical debridement after antibiotic therapy shortens hospital stays, reduces medical costs, provides satisfactory infection control, and prevents complications of long-term systemic antibiotic use. Debridement can be supplemented with the placement of antibiotic-loaded collagen sponges, which has some evidence supporting improved outcomes. Hyperbaric oxygen therapy can be used as an adjunctive modality and may be particularly helpful in cases of chronic osteomyelitis.

• #38 Diagnosis and Treatment Modalities for Osteomyelitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9695195/

  In chronic situations, surgical debridement is typically required. […] The best type, method of administration, and length of antibiotic therapy are still debatable, and the rise of multi-drug resistance pathogens presents significant therapeutic difficulties. […] The fate of patients is significantly influenced by the determination of the underlying cause and subsequent targeted antibiotic therapy. […] To get high doses of the medication into the blood, antibiotics are typically administered initially by IV. […] Antibiotics must be taken for six to eight weeks by adults. […] In patients with persistent refractory osteomyelitis, hyperbaric oxygen treatment (HBOT) is linked to remission rates of 81% to 85% at two to three years. […] Before attempting more extensive surgical treatments, culture-directed antibiotics and HBO2 therapy offer a reasonable chance of curing osteomyelitis.

• #39 Diagnosis and Treatment Modalities for Osteomyelitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9695195/

  In general, HBO2 therapy is administered once per day, five to seven days a week, for 90 to 120 minutes, at 2.0 to 3.0 atmospheres absolute (ATA) pressure. […] The current antibiotic and HBO2 therapy regimen should be continued in cases where rapid clinical improvement is observed for a period of four to six weeks; 20-40 HBO2 treatments are often needed to produce long-lasting therapeutic benefits. […] In addition to antibiotic therapy, surgical debridement is required for the treatment of chronic osteomyelitis since it is characterised by avascular necrosis of the bone and the development of sequestrum (dead bone).

• #40 Osteomyelitis: When Is Specialized Wound Care or Hyperbaric Oxygen Therapy Indicated?

  https://www.trioshealth.org/news/osteomyelitis-when-is-specialized-wound-care-or-hyperbaric-oxygen-therapy-indicated

  The first line of treatment includes aggressive antibiotics and surgical debridement to clean out the infected bone. […] Sometimes antibiotics and traditional wound care practices do not penetrate the bone adequately enough to heal it and the condition becomes chronic (lasting 6 weeks or longer) and refractive (nonresponsive to treatment). In these cases, hyperbaric oxygen therapy (HBOT) may be prescribed in conjunction with an antibiotic regimen. […] During HBOT the patient is given 100 percent oxygen at higher than atmospheric pressure in a hyperbaric chamber with a technician nearby. Increased oxygen in the bloodstream greatly enhances the ability of white blood cells to kill bacteria, reduce swelling and allow new blood vessels to grow more rapidly into affected areas including the tissues and bones. Typically 20-40 HBOT sessions are required to achieve sustained therapeutic benefit for patients with osteomyelitis. Physicians should be aware of HBOT and consider this therapy for appropriate patients.

• #41 Top Hyperbaric Oxygen Therapy for Bone Infections | Atlanta

  http://hbomdga.com/condition/hyperbaric-oxygen-treatment-chronic-refractory-osteomyelitis/

  Chronic Refractory Osteomyelitis (CROM) is a severe bone infection that has not responded to standard treatment methods, including antibiotics and surgical debridement. […] At Regenerative Hyperbaric Medicine, we provide effective and lasting CROM treatment and help patients avoid complications such as chronic pain, disability, and, in severe cases, amputation. […] Hyperbaric Oxygen Therapy (HBOT) serves as a crucial adjunctive therapy. […] By increasing the amount of oxygen available to the infected area, HBOT accelerates tissue repair, enhances the effectiveness of antibiotics, and stimulates the body’s natural healing processes. […] As part of a multi-disciplinary treatment plan, HBOT plays a crucial role in improving healing rates and preventing complications like amputation or further tissue damage.

• #42 Top Hyperbaric Oxygen Therapy for Bone Infections | Atlanta

  http://hbomdga.com/condition/hyperbaric-oxygen-treatment-chronic-refractory-osteomyelitis/

  Chronic Refractory Osteomyelitis (CROM) is a severe bone infection that has not responded to standard treatment methods, including antibiotics and surgical debridement. […] At Regenerative Hyperbaric Medicine, we provide effective and lasting CROM treatment and help patients avoid complications such as chronic pain, disability, and, in severe cases, amputation. […] Hyperbaric Oxygen Therapy (HBOT) serves as a crucial adjunctive therapy. […] By increasing the amount of oxygen available to the infected area, HBOT accelerates tissue repair, enhances the effectiveness of antibiotics, and stimulates the body’s natural healing processes. […] As part of a multi-disciplinary treatment plan, HBOT plays a crucial role in improving healing rates and preventing complications like amputation or further tissue damage.

• #43 10. Osteomyelitis (Refractory) – Undersea & Hyperbaric Medical Society

  https://www.uhms.org/10-osteomyelitis-refractory.html

  In most cases, the best clinical results are obtained when HBO2 therapy is administered in conjunction with culture-directed antibiotics and scheduled to begin soon after thorough surgical debridement. […] Typically, 20-40 postoperative HBO2 sessions will be required to achieve sustained therapeutic benefit. […] In contrast, if prompt clinical response is not noted or osteomyelitis recurs after this initial treatment period, then continuation of the existing antibiotic and HBO2 treatment regimen is unlikely to be effective. Instead, clinical management strategies should be reassessed and additional surgical debridement and/or modification of antibiotic therapy implemented without delay. […] HBO2 therapy has been noted to exert a direct suppressive effect on anaerobic infections. […] In addition to enhanced leukocyte activity, HBO2 helps to augment the transport of certain antibiotics across bacterial cell walls.

• #44 Top Hyperbaric Oxygen Therapy for Bone Infections | Atlanta

  http://hbomdga.com/condition/hyperbaric-oxygen-treatment-chronic-refractory-osteomyelitis/

  Our HBOT offers a promising solution for patients with CROM, especially in critical areas or when standard treatments fail. […] HBOT helps antibiotics penetrate bone tissue more effectively, improving their ability to combat the infection. […] Hyperbaric oxygen therapy can stimulate the immune system, aiding in the fight against infection. […] If traditional treatments, such as antibiotics and surgery, have not been effective in healing your bone infection, Hyperbaric Oxygen Therapy may be a viable option. […] We specialize in hyperbaric oxygen therapy for chronic bone infections, including osteomyelitis and osteoradionecrosis.

• #45 10. Osteomyelitis (Refractory) – Undersea & Hyperbaric Medical Society

  https://www.uhms.org/10-osteomyelitis-refractory.html

  In most cases, the best clinical results are obtained when HBO2 therapy is administered in conjunction with culture-directed antibiotics and scheduled to begin soon after thorough surgical debridement. […] Typically, 20-40 postoperative HBO2 sessions will be required to achieve sustained therapeutic benefit. […] In contrast, if prompt clinical response is not noted or osteomyelitis recurs after this initial treatment period, then continuation of the existing antibiotic and HBO2 treatment regimen is unlikely to be effective. Instead, clinical management strategies should be reassessed and additional surgical debridement and/or modification of antibiotic therapy implemented without delay. […] HBO2 therapy has been noted to exert a direct suppressive effect on anaerobic infections. […] In addition to enhanced leukocyte activity, HBO2 helps to augment the transport of certain antibiotics across bacterial cell walls.

• #46 10. Osteomyelitis (Refractory) – Undersea & Hyperbaric Medical Society

  https://www.uhms.org/10-osteomyelitis-refractory.html

  There is evidence that HBO2 enhances osteogenesis. […] HBO2 therapy’s stimulatory effect on osteoclasts has been confirmed in animal models. […] HBO2 therapy has been shown to be effective in acutely reducing tissue edema, lowering intra-compartmental pressures and ameliorating the detrimental effects of inflammatory reactions.

• #47 10. Osteomyelitis (Refractory) – Undersea & Hyperbaric Medical Society

  https://www.uhms.org/10-osteomyelitis-refractory.html

  There is evidence that HBO2 enhances osteogenesis. […] HBO2 therapy’s stimulatory effect on osteoclasts has been confirmed in animal models. […] HBO2 therapy has been shown to be effective in acutely reducing tissue edema, lowering intra-compartmental pressures and ameliorating the detrimental effects of inflammatory reactions.

• #48 Osteomyelitis Treatment & Management: Approach Considerations, Medical Therapy, Surgical Therapy

  https://emedicine.medscape.com/article/1348767-treatment

  Antibiotic treatment should be based on the identification of pathogens from bone cultures at the time of bone biopsy or debridement. […] Prophylactic treatment with the bead pouch technique has been suggested in open fractures to reduce the risk of infection. Systemic antibiotics supplemented with antibiotic beads are preferred to systemic antibiotics alone. […] Traditionally, antibiotic treatment of osteomyelitis has consisted of a 4- to 6-week course. […] Oral antibiotics that have been proved to be effective include clindamycin, rifampin, trimethoprim-sulfamethoxazole, and fluoroquinolones. […] Empiric therapy is necessary when it is not possible to isolate organisms from the infection site. […] Suppressive antibiotic therapy should also be directed by bone culture and is given orally when surgery is contraindicated.

• #49 SciELO Brazil – Osteomyelitis: an overview of antimicrobial therapy Osteomyelitis: an overview of antimicrobial therapy

  https://www.scielo.br/j/bjps/a/9QfKdN4zxTjncQDwh5BGpcv/

  Parenteral antimicrobial therapy remains the mainstay of antimicrobial therapy for osteomyelitis and is commonly used for 4-6 weeks. […] The local delivery of antibiotics in the treatment of osteomyelitis has been used for decades regardless of the controversy over its effectiveness. […] To supplement oral and systemic antibiotics, local antibiotic delivery has been tried for many years. […] The in situ implantation of a local antibiotic delivery system works to obliterate bacteria in the area as well as to reduce the dead space in the bone. […] Considering the most commonly described microbes causing chronic osteomyelitis, the most widely acceptable antimicrobial agents in local delivery systems are amino glycosides and to a lesser extent various beta-lactam agents and quinolones.

• #50 Osteomyelitis: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2021/1000/p395.html

  Surgical bony debridement followed by drainage of any associated soft tissue abscess continues to be a mainstay of therapy, although there is no clear recommendation about which cases will require debridement. Debridement is typically indicated as part of the initial treatment in the presence of underlying orthopedic hardware and necrotic bone. Stabilization of the bone is an essential component of debridement and can decrease healing time and complications. Surgical debridement after antibiotic therapy shortens hospital stays, reduces medical costs, provides satisfactory infection control, and prevents complications of long-term systemic antibiotic use. Debridement can be supplemented with the placement of antibiotic-loaded collagen sponges, which has some evidence supporting improved outcomes. Hyperbaric oxygen therapy can be used as an adjunctive modality and may be particularly helpful in cases of chronic osteomyelitis.

• #51 SciELO Brazil – Osteomyelitis: an overview of antimicrobial therapy Osteomyelitis: an overview of antimicrobial therapy

  https://www.scielo.br/j/bjps/a/9QfKdN4zxTjncQDwh5BGpcv/

  Osteomyelitis treatment implies the administration of high doses of antibiotics (AB) by means of endovenous and oral routes and should take a period of at least 6 weeks. […] Local drug delivery systems, using non-biodegradable (polymethylmethacrylate) or biodegradable and osteoactive materials such as calcium orthophosphates bone cements, have been shown to be promising alternatives for the treatment of osteomyelitis. […] The treatment of chronic osteomyelitis is more complicated and requires a multidisciplinary approach in 3 phases: surgical debridement, systemic antibiotic therapy for 4 to 6 weeks and local antibiotic delivery systems. […] The primary goal of treatment is remission of the disease, which is defined as the absence of any sign of infection, in the initial or contiguous location, at least one year after the end of antimicrobial therapy.

• #52 SciELO Brazil – Osteomyelitis: an overview of antimicrobial therapy Osteomyelitis: an overview of antimicrobial therapy

  https://www.scielo.br/j/bjps/a/9QfKdN4zxTjncQDwh5BGpcv/

  The most commonly used non-biodegradable carrier material has long been PMMA in the form of beads or bone cement. […] A novel number of biodegradable carriers systems have been developed in recent years with promising clinical potential, combining local delivery of the drug with osteogenic potential.

• #53 Diagnosis and Treatment Modalities for Osteomyelitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9695195/

  Osteomyelitis is an infection-related inflammatory disease of the bones. […] The main course of treatment should be antibiotics, which should be chosen depending on the findings of the culture and the characteristics of each patient. […] Surgery used to try to remove infected and necrotic bone worsens the patient’s condition. […] As a result of new biomaterials entering the market, such as bioactive glass S53P4 (BonAlive, Bonalive Biomaterials Ltd., Turku, Finland) and CeramentTM G (Bonesupport, Lund, Sweden), osteomyelitis therapy is gradually moving from a two-stage to a one-stage approach in the Western world. […] If an imaging examination reveals osteomyelitis, then start antibiotics right away. […] Medical treatment entails correcting any host inadequacies, choosing an initial antibiotic, and modifying that antibiotic based on culture results.

• #54 Osteomyelitis Treatment & Management: Approach Considerations, Medical Therapy, Surgical Therapy

  https://emedicine.medscape.com/article/1348767-treatment

  The induced membrane technique (Masquelet technique) is a two-stage procedure that requires a robust preoperative assessment of the patient and planning of the surgical procedures. […] Vascularized bone grafts are indicated when the skeletal defect is longer than 6 cm. […] Negative-pressure wound therapy (NPWT) has increasingly become a popular treatment for the management of both acute and chronic wounds. […] Adjunctive hyperbaric oxygen therapy (HBOT) can promote collagen production, angiogenesis, and healing in an ischemic or infected wound. […] In patients without retained hardware, a course of IV antibiotics for at least 6 weeks is recommended, with weekly blood chemistries and inflammatory markers at the beginning and end of antibiotic therapy to monitor for recurrence. […] For patients with retained hardware, an extended course of antibiotics is recommended for at least 6 weeks.

• #55 Osteomyelitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK532250/

  Vacuum-assisted wound closure devices are used in the right clinical setting, especially where large or deep wounds are left after extensive debridement. […] Patient education about the prolonged nature of therapy and the need for compliance with treatment recommendations to ensure adequate wound healing thereby reducing the risk for recurrence is an essential part of the care in these patients. […] The therapeutic approach to management is guided sometimes by the site of infection and the presence of vascular insufficiency. […] Following surgical debridement, the need for close follow-up with prolonged antibiotics and meticulous wound care cannot be overemphasized.

• #56 Osteomyelitis Treatment & Management: Approach Considerations, Medical Therapy, Surgical Therapy

  https://emedicine.medscape.com/article/1348767-treatment

  The Ilizarov technique is usually well tolerated by the patient, with little associated pain. […] Operative treatment consists of the following: Adequate drainage, Extensive debridement of necrotic tissue, Management of dead space, Adequate soft-tissue coverage, Restoration of blood supply. […] Remission or cure is most likely with extensive debridement, obliteration of dead space, removal of any hardware, and appropriate antibiotic therapy. […] Dead space must be filled with durable vascularized tissue, sometimes from the fibula or ilium. Antibiotic-impregnated beads may be used for temporary sterilization of dead space. […] Given that a central tenet in surgical management of osteomyelitis involves filling in the dead space with viable vascularized tissue, it is not surprising that various ways of filling the defect and maximizing local antibiotic delivery have been engineered.

• #57 Osteomyelitis Treatment & Management: Approach Considerations, Medical Therapy, Surgical Therapy

  https://emedicine.medscape.com/article/1348767-treatment

  The induced membrane technique (Masquelet technique) is a two-stage procedure that requires a robust preoperative assessment of the patient and planning of the surgical procedures. […] Vascularized bone grafts are indicated when the skeletal defect is longer than 6 cm. […] Negative-pressure wound therapy (NPWT) has increasingly become a popular treatment for the management of both acute and chronic wounds. […] Adjunctive hyperbaric oxygen therapy (HBOT) can promote collagen production, angiogenesis, and healing in an ischemic or infected wound. […] In patients without retained hardware, a course of IV antibiotics for at least 6 weeks is recommended, with weekly blood chemistries and inflammatory markers at the beginning and end of antibiotic therapy to monitor for recurrence. […] For patients with retained hardware, an extended course of antibiotics is recommended for at least 6 weeks.

• #58 Osteomyelitis – Treatments

  https://mydoctor.kaiserpermanente.org/mas/structured-content/Treatment_Osteomyelitis_-_Treatments.xml?co=/regions/mas

  Our first goal is to prevent osteomyelitis from spreading. […] Immobilization. To improve healing, we may support the infected bone in a cast or other device. Children with osteomyelitis in a leg or arm bone often need this. […] We may use needle aspiration or minor surgery to drain fluid from a wound. […] Surgery may be needed to remove: Bone areas that have died due to chronic or acute osteomyelitis. This is called debridement. […] Self-care is important for healing. Follow these guidelines: Take your medications as prescribed. […] If an osteomyelitis infection doesn’t respond to antibiotic treatment or becomes chronic, the infection can spread. […] We sometimes need to treat these problems by removing dead bone, tissue surrounding the bone, or even partial amputation of the limb. […] Good self-care is important for the healing process.

• #59 Osteomyelitis: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2021/1000/p395.html

  Osteomyelitis treatment requires a multifaceted approach that may include antibiotics, surgical intervention, and other modalities depending on multiple clinical factors, including clinical stage. Clinical staging guides decision-making when choosing specific surgical treatments and limits the need for amputation. The 2015 modification of the Cierny-Mader staging system (developed in 1985) is commonly used and classifies osteomyelitis based on the anatomic location and the physiologic condition of the patient. Anatomic types include medullary (stage 1), superficial (stage 2), localized (stage 3), and diffuse (stage 4), with higher stages requiring more complex surgical intervention. The physiologic condition of the patient (host) can be classified as type A (normal immune response and healthy vascular system), type B (local immunocompromise), or type C (noncandidate for surgery). In those classified as type C, treatment is expected to cause more harm than the disease process itself, so the focus of care shifts from cure to palliation.

• #60 Osteomyelitis: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2021/1000/p395.html

  Osteomyelitis treatment requires a multifaceted approach that may include antibiotics, surgical intervention, and other modalities depending on multiple clinical factors, including clinical stage. Clinical staging guides decision-making when choosing specific surgical treatments and limits the need for amputation. The 2015 modification of the Cierny-Mader staging system (developed in 1985) is commonly used and classifies osteomyelitis based on the anatomic location and the physiologic condition of the patient. Anatomic types include medullary (stage 1), superficial (stage 2), localized (stage 3), and diffuse (stage 4), with higher stages requiring more complex surgical intervention. The physiologic condition of the patient (host) can be classified as type A (normal immune response and healthy vascular system), type B (local immunocompromise), or type C (noncandidate for surgery). In those classified as type C, treatment is expected to cause more harm than the disease process itself, so the focus of care shifts from cure to palliation.

• #61 Osteomyelitis – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/osteomyelitis/symptoms-causes/syc-20375913

  Most people with osteomyelitis need surgery to remove areas of the affected bone. After surgery, most often people need strong antibiotics given through a vein. […] Osteomyelitis complications may include: Bone death, also called osteonecrosis. An infection in your bone can block blood flow within the bone, leading to bone death. If you have areas where bone has died, you need surgery to remove the dead tissue for antibiotics to work. […] If you have an increased risk of infection, talk with your healthcare professional about ways to prevent infections. Cutting your risk of infection will cut your risk of osteomyelitis.

• #62 Osteomyelitis: Practice Essentials, Anatomy, Pathophysiology

  https://emedicine.medscape.com/article/785020-medication

  The prognosis of osteomyelitis depends on etiology, patient factors, and time to institution of suitable treatment, as well as a host of other factors (eg, location, organism, and antibiotic susceptibility and sensitivity). […] The complications of osteomyelitis, with all the comorbid factors and etiologic factors having been taken into account, can be extremely varied and may include sepsis and multiorgan dysfunction, stiffness, deformity, chronic discharging sinuses, limb-length discrepancies, chronic pain, loss of function, amputation, and even secondary cancers in sinus sites.

• #63 Osteomyelitis: Practice Essentials, Anatomy, Pathophysiology

  https://emedicine.medscape.com/article/785020-medication

  The prognosis of osteomyelitis depends on etiology, patient factors, and time to institution of suitable treatment, as well as a host of other factors (eg, location, organism, and antibiotic susceptibility and sensitivity). […] The complications of osteomyelitis, with all the comorbid factors and etiologic factors having been taken into account, can be extremely varied and may include sepsis and multiorgan dysfunction, stiffness, deformity, chronic discharging sinuses, limb-length discrepancies, chronic pain, loss of function, amputation, and even secondary cancers in sinus sites.

• #64 Osteomyelitis: Practice Essentials, Anatomy, Pathophysiology

  https://emedicine.medscape.com/article/785020-medication

  The prognosis of osteomyelitis depends on etiology, patient factors, and time to institution of suitable treatment, as well as a host of other factors (eg, location, organism, and antibiotic susceptibility and sensitivity). […] The complications of osteomyelitis, with all the comorbid factors and etiologic factors having been taken into account, can be extremely varied and may include sepsis and multiorgan dysfunction, stiffness, deformity, chronic discharging sinuses, limb-length discrepancies, chronic pain, loss of function, amputation, and even secondary cancers in sinus sites.

• #65 Osteomyelitis: Practice Essentials, Anatomy, Pathophysiology

  https://emedicine.medscape.com/article/785020-medication

  The prognosis of osteomyelitis depends on etiology, patient factors, and time to institution of suitable treatment, as well as a host of other factors (eg, location, organism, and antibiotic susceptibility and sensitivity). […] The complications of osteomyelitis, with all the comorbid factors and etiologic factors having been taken into account, can be extremely varied and may include sepsis and multiorgan dysfunction, stiffness, deformity, chronic discharging sinuses, limb-length discrepancies, chronic pain, loss of function, amputation, and even secondary cancers in sinus sites.

• #66 Osteomyelitis: Practice Essentials, Anatomy, Pathophysiology

  https://emedicine.medscape.com/article/785020-medication

  The prognosis of osteomyelitis depends on etiology, patient factors, and time to institution of suitable treatment, as well as a host of other factors (eg, location, organism, and antibiotic susceptibility and sensitivity). […] The complications of osteomyelitis, with all the comorbid factors and etiologic factors having been taken into account, can be extremely varied and may include sepsis and multiorgan dysfunction, stiffness, deformity, chronic discharging sinuses, limb-length discrepancies, chronic pain, loss of function, amputation, and even secondary cancers in sinus sites.

• #67 Osteomyelitis: Practice Essentials, Anatomy, Pathophysiology

  https://emedicine.medscape.com/article/785020-medication

  The prognosis of osteomyelitis depends on etiology, patient factors, and time to institution of suitable treatment, as well as a host of other factors (eg, location, organism, and antibiotic susceptibility and sensitivity). […] The complications of osteomyelitis, with all the comorbid factors and etiologic factors having been taken into account, can be extremely varied and may include sepsis and multiorgan dysfunction, stiffness, deformity, chronic discharging sinuses, limb-length discrepancies, chronic pain, loss of function, amputation, and even secondary cancers in sinus sites.

• #68 Osteomyelitis: Practice Essentials, Anatomy, Pathophysiology

  https://emedicine.medscape.com/article/785020-medication

  The prognosis of osteomyelitis depends on etiology, patient factors, and time to institution of suitable treatment, as well as a host of other factors (eg, location, organism, and antibiotic susceptibility and sensitivity). […] The complications of osteomyelitis, with all the comorbid factors and etiologic factors having been taken into account, can be extremely varied and may include sepsis and multiorgan dysfunction, stiffness, deformity, chronic discharging sinuses, limb-length discrepancies, chronic pain, loss of function, amputation, and even secondary cancers in sinus sites.

• #69 Diagnosis and Management of Osteomyelitis | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/1101/p1027.html

  Despite the use of surgical debridement and long-term antibiotic therapy, the recurrence rate of chronic osteomyelitis in adults is about 30 percent at 12 months. Recurrence rates in cases involving P. aeruginosa are even higher, nearing 50 percent. The optimal duration of antibiotic treatment and route of delivery are unclear. For chronic osteomyelitis, parenteral antibiotic therapy for two to six weeks is generally recommended, with a transition to oral antibiotics for a total treatment period of four to eight weeks. Long-term parenteral therapy is likely as effective as transitioning to oral medications, but has similar recurrence rates with increased adverse effects. In some cases, surgery is necessary to preserve viable tissue and prevent recurrent systemic infection. […] Antibiotic regimens for the empiric treatment of acute osteomyelitis, particularly in children, should include an agent directed against S. aureus. Betalactam antibiotics are first-line options unless MRSA is suspected. If methicillin resistance among community isolates of Staphylococcus is greater than 10 percent, MRSA should be considered in initial antibiotic coverage. Intravenous vancomycin is the first-line choice. In patients with diabetic foot infections or penicillin allergies, fluoroquinolones are an alternate option for staphylococcal infections; these agents seem to be as effective as beta-lactams.

• #70 Osteomyelitis: Practice Essentials, Anatomy, Pathophysiology

  https://emedicine.medscape.com/article/785020-medication

  The prognosis of osteomyelitis depends on etiology, patient factors, and time to institution of suitable treatment, as well as a host of other factors (eg, location, organism, and antibiotic susceptibility and sensitivity). […] The complications of osteomyelitis, with all the comorbid factors and etiologic factors having been taken into account, can be extremely varied and may include sepsis and multiorgan dysfunction, stiffness, deformity, chronic discharging sinuses, limb-length discrepancies, chronic pain, loss of function, amputation, and even secondary cancers in sinus sites.

• #71 Osteomyelitis (Bone Infection): Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/osteomyelitis-bone-infection

  Osteomyelitis is a serious infection that happens when bacteria or fungi infect your bone marrow. It can cause permanent bone damage if its not treated right away. […] Your provider will suggest treatments to kill the infection and prevent permanent bone damage. The most common osteomyelitis treatments include: […] Youll need antibiotics to cure a bacterial infection. You may need intravenous (IV) antibiotics for a few weeks before taking oral (pills you take by mouth) antibiotics for several weeks afterward. […] Antifungals treat fungal infections. Youll probably need oral antifungal medications for several months. […] You may need surgery if the bone infection is severe or you have a high risk of complications. […] Most people with osteomyelitis recover without long-term complications. But its important to get the infection diagnosed and start treatment right away.

• #72 Osteomyelitis (Bone Infection): Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/osteomyelitis-bone-infection

  Osteomyelitis is a serious condition that needs treatment right away. It usually responds very well to treatment, but you need to start treating it as soon as possible to prevent serious complications. […] No, osteomyelitis wont go away on its own. Its extremely important to see a healthcare provider for a diagnosis and treatment. Your immune system does an amazing job of fighting off germs and other invaders, but you need antibiotics or antifungals to kill the infections that cause osteomyelitis.

• #73 Azthena logo with the word Azthena

  https://www.news-medical.net/news/20190131/Researchers-develop-a-new-treatment-for-osteomyelitis.aspx

  A team of researchers led by RCSI (Royal College of Surgeons in Ireland), have developed a new treatment for the particularly difficult-to-treat bone infection, osteomyelitis. […] The new treatment has developed a one-step solution that kills bacteria and promotes bone growth without using antibiotics. […] The ability of a single implant to improve blood flow and enhance bone healing as well as inhibit infection without antibiotic treatment is a significant advancement over most existing treatments. […] „Osteomyelitis is notoriously difficult to treat. Further work on the back of this research could lead to the complete development of a single-stage, off-the-shelf treatment. This in turn could reduce the need for antibiotics and bone grafting – thus also addressing issues with antibiotic resistance” said first author Emily Ryan, a recently qualified PhD student in the RCSI Department of Anatomy.

• #74 Azthena logo with the word Azthena

  https://www.news-medical.net/news/20190131/Researchers-develop-a-new-treatment-for-osteomyelitis.aspx

  A team of researchers led by RCSI (Royal College of Surgeons in Ireland), have developed a new treatment for the particularly difficult-to-treat bone infection, osteomyelitis. […] The new treatment has developed a one-step solution that kills bacteria and promotes bone growth without using antibiotics. […] The ability of a single implant to improve blood flow and enhance bone healing as well as inhibit infection without antibiotic treatment is a significant advancement over most existing treatments. […] „Osteomyelitis is notoriously difficult to treat. Further work on the back of this research could lead to the complete development of a single-stage, off-the-shelf treatment. This in turn could reduce the need for antibiotics and bone grafting – thus also addressing issues with antibiotic resistance” said first author Emily Ryan, a recently qualified PhD student in the RCSI Department of Anatomy.

• #75 Treatment of MRSA-infected osteomyelitis using bacterial capturing, magnetically targeted composites with microwave-assisted bacterial killing | Nature Communications

  https://www.nature.com/articles/s41467-020-18268-0

  Owing to the poor penetration depth of light, phototherapy, including photothermal and photodynamic therapies, remains severely ineffective in treating deep tissue infections such as methicillin-resistant Staphylococcus aureus (MRSA)-infected osteomyelitis. Here, we report a microwave-excited antibacterial nanocapturer system for treating deep tissue infections that consists of microwave-responsive Fe3O4/CNT and the chemotherapy agent gentamicin (Gent). This system, Fe3O4/CNT/Gent, is proven to efficiently target and eradicate MRSA-infected rabbit tibia osteomyelitis. Its robust antibacterial effectiveness is attributed to the precise bacteria-capturing ability and magnetic targeting of the nanocapturer, as well as the subsequent synergistic effects of precise microwaveocaloric therapy from Fe3O4/CNT and chemotherapy from the effective release of antibiotics in infection sites. The advanced target-nanocapturer of microwave-excited microwaveocaloric-chemotherapy with effective targeting developed in this study makes a major step forward in microwave therapy for deep tissue infections.

• #76 Investigating the Pipeline for Osteomyelitis Treatment Landscape

  https://www.delveinsight.com/blog/osteomyelitis-treatment-outlook

  The osteomyelitis treatment space has witnessed several clinical trials coming to a halt due to unfavorable clinical outcomes. Although the current osteomyelitis pipeline is restricted to just two products, they seem promising, having shown impressive results in other indications and gaining regulatory approval globally. The major late-stage products likely to hit the osteomyelitis treatment market include DALVANCE (dalbavancin) and Ceftobiprole medocaril. Improved methods of delivering antibiotics are being explored, and antimicrobial resistance remains a major challenge, compelling the development of novel therapeutics for osteomyelitis treatment. […] According to DelveInsights analysis, the osteomyelitis market was valued at approximately USD 400 million in 2021 and is expected to reach USD 650 million by 2032 at a CAGR of 4.4%. The development of disease-specific therapies for osteomyelitis will auger well for the market landscape, which will likely bring significant changes in the osteomyelitis treatment space during the forecast period (2019-2032). However, further research into current healthcare pathways clearly shows a need for further therapeutic trials to improve osteomyelitis treatment options.

• #77 Osteomyelitis: Symptoms, causes, complications, and treatment

  https://www.medicalnewstoday.com/articles/178819

  When osteomyelitis has destroyed some bone, the surgeon typically removes as much of this area as possible, plus a small margin of healthy bone, and any surrounding tissue with signs of infection. […] This is important if the infection has limited the flow of blood. […] If necessary, the surgeon may need to take out prostheses, such as surgical plates or screws, from prior surgeries. […] If the person is not well enough to have surgery, the doctor may rely on long-term IV antibiotics. […] Successful treatment requires a person to follow all guidance extremely carefully.

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