Osteomyelitis - Treatment

Optimal antibiotic therapy, appropriate dosing and therapy long enough to monitor clinical response and toxicity are essential.Antibiotic treatment is initiated promptly, preferably after they got sucked blood and bone samples for bacterial culture. Many antimicrobial agents are selected to cover common pathogens.Choose an antistaphylococcal antibacterial: nafcillin, vancomycin, and cefazolin clinidamicina are preferred agents. Consider clindamycin as an alternative to vancomycin in empiric therapy for patients living in communities with high incidence of S. pneumoniae resistant to penicillin or methicillin-resistant S. aureus.Cefuroxime, a second generation cephalosporin can be used as a single agent against Hemofilus influenzae and S. aureus resistant to methicillin. When to treat neonatal osteomyelitis indicate nafcillin and tobramycin or cefotaxime to cover the family Enterobacter bacteria, S. aureus and Streptococcus group B
After the arrival of the bacterial culture results initiates appropriate antibiotics. Treatment of osteomyelitis is represented by parenteral antibiotics to penetrate the joints and bones. Treatment is indicated at least 4-6 weeks. after intravenous antibiotic therapy can be continued orally Depending on the type and location of infection.In patients with sickle cell disease and osteomyelitis, the main bacterial causes are S. aureus and Slamonella species. The main option for treatment is a fluoroquinolone antibiotic, or a third-generation cephalosporin.When they suspect a puncture wound through the right route of transmission, infected agents are S. aureus and Pseudomonas aeruginosa. Antibiotics for this infection include ceftazidime or cefepim. Ciprofloxacin is an alternative.
Surgical therapy:In case of injury to indicate aggressive open biopsy for culture and histology. Other lesions are incised and drained when indicated.When no clinical signs indicating subperiosteal pus drainage and incision. When clinical signs of synovitis are present, possibly with pus in the joint is made artrotomia and synovium is sent to the culture and histology. If the cavities of the metaphyses and epiphyses chiureteaza communicate with the joint. Curettage is indicated if symptoms of infection persist or recur during medical treatment.
Prognosis:Morbidity can be significant and include the extension of the infection localized to adjacent tissues or joints, as progression to chronic pain and disability, amputation of the affected extremity, generalized infection or sepsis. Up to 10-15% of patients with vertebral osteomyelitis will develop neurologic sequelae or spinal cord compression. Up to 30% of pediatric patients with osteomyelitis of long bones will develop deep vein thrombosis. The mortality rate is low, unless associated sepsis or other pathological condition of the fund.