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Osteomlytis

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10 views2 pages

Osteomlytis

Uploaded by

yasmeenhesham086
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Osteomyelitis

Definiation Infection of the bone with subsequent bone destruction


Signs and symptoms a. Fever and chills
b. Localized pain, tenderness, and swelling
c. Neurologic symptoms if spinal cord compression
Laboratory tests a. Elevated WBC
b. Elevated erythrocyte sedimentation rate
c. Elevated C-reactive protein
Diagnostic tests a. Radiographic tests: Positive results lag behind infectious process.
b. Computed tomography and magnetic resonance imaging scans
c. Radionuclide imaging: Positive as soon as 24–48 hours after infectious process
begins.

Empiric Therapy
1- Pediatric (neonate therapy a. Cefazolin
should be tailored to the b. Nafcillin, oxacillin
patient) c. Clindamycin (use if prevalence of MRSA in community is 10% or more)
d. Vancomycin (use if prevalence of MRSA and clindamycin-resistant S. aureus in
community is 10% or more)
2- Adult a. Nafcillin, oxacillin, cefazolin, ceftriaxone, clindamycin, or vancomycin
(alternatives linezolid or daptomycin)
b. Choose additional antibiotics according to patient-specific characteristics
3- Patients with sickle cell Ceftriaxone/cefotaxime or ciprofloxacin/levofloxacin (no studies assessing best
anemia empiric therapy)
4- Prosthetic joint infections
a. Debridement and retention of i. Staphylococcal: Pathogen-specific intravenous therapy plus rifampin
prosthesis or one-stage 300–450 mg twice daily for 2–6 weeks, followed by rifampin plus ciprofloxacin or
exchange of prosthesis levofloxacin for 3 months (hip, elbow, shoulder, ankle prosthesis) or 6 months
(knee prosthesis)

ii. Non-staphylococcal: Pathogen-specific intravenous (or highly bioavailable oral)


therapy for 4–6 weeks, followed by indefinite oral suppression therapy
b. Resection of prosthesis with a. Pathogen-specific intravenous (or highly bioavailable oral) therapy for 4–6
or without planned weeks
reimplantation or amputation
b. Only 24–48 hours of antibiotic therapy after amputation if all infected tissue is
removed

Therapy Length
Acute osteomyelitis: 4–6 week
Chronic osteomyelitis: 6–8 weeks of parenteral therapy and 3–12 months of oral therapy

Criteria for Effective Oral Therapy for Osteomyelitis


1- High bioavailability antibiotic is available 2- Adherence 3- Resolving clinical cours
4- Identified organism that is highly susceptible to the oral antibiotic used
5- C-reactive protein less than 2.0 mg/dL 6- Adequate surgical debridement ,

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