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Bone infection - Treating osteomyelitis

NHS Choices Medical Reference

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Osteomyelitis is usually treated with antibiotics, although surgery may also be used in severe cases.

Treating acute osteomyelitis

Acute osteomyelitis can usually be successfully treated using a course of antibiotics for at least four to six weeks. 

For part of the treatment you will need to take the medicine intravenously (directly into a vein), usually while in hospital. If you are well enough, you may be able to receive the injections as an outpatient, so you can go home the same day. 

After your symptoms start to improve, a switch is usually made to antibiotic tablets you can take at home.

In cases of osteomyelitis, there is usually a choice of antibiotics available to treat the infection and often two antibiotics are used in combination. This is known as dual therapy.

Occasionally, the bacteria causing the infection are resistant to standard antibiotics and less frequently used antibiotics are needed.

All antibiotics have side effects, which you should discuss with your GP or the doctor in charge of your care.

In the rarer cases where a fungal infection has caused osteomyelitis, antifungal medications are used.

Painkillers may also be used if the condition is causing you discomfort.

Read more about the medications used in the medicines guide for osteomyelitis.

Treating chronic osteomyelitis

People with chronic osteomyelitis will usually require a combination of antibiotics and surgery. Surgery may be used to remove bone, to drain pus from a wound or abscess, or to remove and replace a joint replacement if it was the cause of infection.

If there is extensive bone damage, it will be necessary to surgically remove any diseased bone and tissue. This procedure is known as debridement.

Debridement can often leave an empty space in the bone, which is sometimes packed with antibiotic-loaded cement. If the surgeon does this, a second operation will be required to remove the cement within a few weeks of the first. Bone may also be taken from elsewhere in your body, often from around the hip, to replace the damaged bone.

In some cases, it may also be necessary to transfer muscle and skin from another part of the body to repair the tissue surrounding the affected bone.

Hyperbaric oxygen therapy

Some researchers have argued that a type of non-surgical treatment called hyperbaric oxygen therapy may be useful in treating cases of both acute and chronic osteomyelitis that do not respond to conventional treatment.

During hyperbaric oxygen therapy, you are placed in a specially designed chamber, similar to a decompression chamber used by divers.

The chamber is filled with oxygen, administered at a much higher pressure (hyperbaric) than the normal level of oxygen in the atmosphere. The high levels of oxygen are thought to speed up the healing process and slow the spread of infection.

There is currently only limited evidence supporting the effectiveness of hyperbaric oxygen therapy for treating osteomyelitis. From the evidence available, it would appear it is most effective in treating osteomyelitis associated with a diabetic foot ulcer. 

However, the National Institute of Health and Care Excellence (NICE) recently announced that oxygen therapy should only be used to treat diabetic foot ulcers as part of a clinical trial.

Medical Review: October 16, 2012
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