How is osteomyelitis treated?

The objective of treating osteomyelitis is to eliminate the infection and prevent the development of chronic infection. Chronic osteomyelitis can lead to permanent deformity, possible fracture, and chronic problems, so it is important to treat the disease as soon as possible.

Drainage: If there is an open wound or abscess, it may be drained through a procedure called needle aspiration. In this procedure, a needle is inserted into the infected area and the fluid is withdrawn. For culturing to identify the bacteria, deep aspiration is preferred over often-unreliable surface swabs. Most pockets of infected fluid collections (pus pocket or abscess) are drained by open surgical procedures. The reason for this is that antibiotics are ineffective at reaching pockets of infected fluid as they have no blood supply.

Antibiotic medications: Prescribing antibiotics is the first step in treating osteomyelitis. Antibiotics help the body get rid of bacteria in the bloodstream that may otherwise re-infect the bone. The dosage and type of antibiotic prescribed depends on the type of bacteria present and the extent of infection. While antibiotics are often given intravenously, some are also very effective when given in an oral dosage. It is important to first identify the offending organism through blood cultures, aspiration, and biopsy so that the organism is not masked by an initial inappropriate dose of antibiotics. The preference is to first make attempts to do procedures (aspiration or bone biopsy) to identify the organisms prior to starting antibiotics.

Surgery: Most well-established bone infections are managed through open surgical procedures during which the destroyed bone is scraped out. In the case of spinal abscesses, surgery is not performed unless there is compression of the spinal cord or nerve roots. Instead, patients with spinal osteomyelitis are given intravenous antibiotics. After surgery, antibiotics against the specific bacteria involved in the infection are then intensively administered during the hospital stay and for many weeks afterward.

Last reviewed by a Cleveland Clinic medical professional on 11/28/2017.

References

  • Ryan KJ, Ray C. Chapter 58. Bone and Joint Infections. In: Ryan KJ, Ray C. eds. Sherris Medical Microbiology, 5e. New York, NY: McGraw-Hill; 2010.
  • Grad YH, Ross JJ. Chapter 200. Osteomyelitis and Septic Arthritis. In: McKean SC, Ross JJ, Dressler DD, Brotman DJ, Ginsberg JS. eds. Principles and Practice of Hospital Medicine. New York, NY: McGraw-Hill; 2012. library.ccf.org Accessed 3/13/2018.
  • State Government of Victoria. Better Health Channel. Osteomyelitis Accessed 3/13/2018.
  • Journal of the American Medical Association. JAMA Patient Page: Osteomyelitis Accessed 3/13/2018.

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