Go to a hospital emergency department or an urgent care clinic if severe pain develops when your primary care physician's office is closed. During a visit to an urgent care center or emergency department, your physician will conduct an examination and order tests. Following a diagnosis of osteomyelitis, antibiotics will be administered intravenously or by injection. Your physician may consult with orthopedists, surgeons, or infectious disease specialists, and you will be admitted to the hospital for treatment.
You can take steps after a short hospital stay to make sure your treatment continues to be effective. You may be sent home while still receiving intravenous medication, or when you are able to take oral antibiotics. Once at home, you should continue taking medication as directed and rest in bed until several weeks after the symptoms disappear. Various medical devices are available that allow you to undergo IV drug therapy at home, if necessary, with therapy monitored either by visits to a physician's office or clinic, or by home health care nurses.
Recovery from osteomyelitis usually requires extended periods of bed rest. During the time you spend in bed rest, you should maintain some level of activity to prevent bed sores from developing. As vigorous activities may interfere with recovery, or harm the infected area, normal activities should be resumed gradually according to your doctor's advice. Pain relievers may be taken as needed, following the recommendation of your doctor.
Your doctor is the best source of information on the drug treatment choices available to you.
Surgery is necessary in some cases of acute osteomyelitis, and repeated surgeries may be needed to treat chronic osteomyelitis. Surgery is performed to remove infected tissue or bone, or to drain an abscess or an open wound. The type of surgery depends on the extent of the infection. If an infection is related to an implanted orthopedic device such as an artificial knee, the device may be surgically removed. Often, a new device is implanted during the same procedure. A foreign object causing infection, such as a bullet, would also be removed surgically. Surgical procedures are usually performed in the hospital under general anesthesia.
Cases of chronic osteomyelitis that involve recurrent infections and wound drainage despite antibiotic treatment may require a surgical technique called complete surgical debridement. Complete surgical debridement involves a series of surgeries over several days, during which all infected bone and tissue is removed. The space where dead tissue was removed is filled with healthy bone, muscle, or skin, and steps will be taken to re-establish the blood supply to the area. High doses of antibiotics are given before and after treatment to fight infection.
In extreme cases of chronic osteomyelitis, it may be necessary to amputate an infected limb. Amputation is usually recommended only if repeated surgeries and ongoing antibiotic therapy have not been able to eliminate the infection.
Some patients may undergo plastic surgery following treatment for osteomyelitis. Plastic surgery is used to improve the appearance or function of tissues that were damaged by the infection, or by surgery itself. Procedures that may be needed include bone grafts, muscle grafts, and skin grafts.
Tuberculosis can trigger a specific form of osteomyelitis. Tuberculosis osteomyelitis (also called skeletal tuberculosis) occurs when tuberculosis spreads to the bone, and particularly the spine. Symptoms of tuberculosis osteomyelitis include fever, chills, anorexia, weight loss, and local swelling. Tuberculosis osteomyelitis is treated with the same anti-TB medications used for the pulmonary form of tuberculosis.
In children with sickle cell anemia, the causes and symptoms of osteomyelitis may be different from those of children who are otherwise healthy. In children with sickle cell anemia, the Salmonella bacteria rather than the more common S. aureus bacteria is more likely to be responsible for the infection. In addition, the bacteria that cause osteomyelitis tend to cluster in the shaft of the long bones rather than in the ends of the bones in children with sickle cell anemia.
Patients with vertebral osteomyelitis are usually treated with antibiotics for four to six weeks, and are advised to rest in bed until the pain has eased and they can comfortably move. Surgery is rarely needed except to stabilize the vertebrae or drain abscesses.
Most patients recover with no long-term complications if osteomyelitis is diagnosed promptly and treated adequately.
The prognosis for patients with chronic osteomyelitis depends on the success of the surgery and antibiotic treatment. The success of treatment for chronic osteomyelitis depends largely on the surgeon's ability to remove all of the dead bone and damaged tissue. Unfortunately, it is not always possible to determine during surgery whether all of the affected bone and tissue has been removed. If it is not, lingering bacteria may cause recurrent infections that require more antibiotic treatments and further surgery. Amputation may be necessary if the infection cannot be cured.
Two periods of follow-up generally occur: one while treatment is still underway (in the patient's home), and the second after the drug therapy has ended. Before leaving the hospital and switching to outpatient treatment, you should be taught how to use the catheter, the pump that will be used to deliver the antibiotics. Parents or other caregivers responsible for children with osteomyelitis should also learn how to use and maintain the device. A home health nurse should then visit you at home at least once a week to coordinate care with the hospital and physician.
Laboratory tests will be performed every few weeks during treatment to look for signs that your condition is improving. These tests can also alert the physician to any allergic reactions to the antibiotic. Once treatment has been completed, your physician may schedule check-ups, lab tests, and imaging scans every four to six months, or as needed to monitor your progress.
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