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17.1 Infections

Table of Contents

17.1.1 Osteomyelitis

Osteomyelitis is an infection of the bone, and is most common in children under 12 years. Staphylococci are the most frequent responsible organisms. Salmonella osteomyelitis infection is a common complication of sickle cell disease. Tuberculosis osteomyelitis occurs in association with having tuberculosis.

Diagnostic Criteria

  • Fever, malaise and severe pain at the site of bone infection in acute osteomyelitis
  • If the infection is close to a joint there may be a ‘sympathetic’ effusion

Investigations

  • Total and differential WBC
  • CRP
  • Urinalysis, urine for culture and sensitivity
  • Blood for culture and sensitivity
  • Pus for culture and sensitivity
  • Plain X-ray (Note: The first radiological sign appears 12–14 days after onset).

Pharmacological Treatment

Table 17.1: Types of Bone Infection and Treatment

Condition Treatment Duration
Acute osteomyelitis Surgical drainage (recommended in all cases

presenting with history > 24 hours)

B: Cloxacillin (IV) 1–2 g 6 hourly

OR

S: Clindamycin (IV) 600 mg 8 hourly.

See Notes on Acute Osteomyelitis in the text.

6 weeks or stop at 3 weeks if X-ray normal
Chronic osteomyelitis Surgery. Antibiotics not generally recommended
Osteomyelitis in patient with sickle cell anemia A: Ampicillin (IV) 2 g 6 hourly

Plus

B: Cloxacillin (IV) 1–2 g 6 hourly

Plus

B: Chloramphenicol (IV) 500 mg 6 hourly (if salmonella is suspected)

5 to 12 weeks

 

6 to 12 weeks

 

2 to 3 weeks

Septic arthritis Surgical drainage

B: Cloxacillin

OR

S: Clindamycin as for acute osteomyelitis

Gonococcal arthritis A: Benzyl penicillin (IV) 2.5–5 MU 6 hourly or (if penicillin resistant)

S: Kanamycin (IM) 2 g once daily

6 days

 

7 days

Open fracture (no infection established B: Cloxacillin (IV) 1 g 6 hourly

OR

S: Clindamycin (IV) 600 mg 8 hourly
A:
 Ceftriaxone 1 g 8 hourly

3 days

17.1.2 Tropical Pyomyositis

This is a condition whereby there is pyogenic infection of large muscle/muscles with extensive necrosis of the involved muscle. This condition occurs more commonly in the tropics.

The cause of tropical pyomyositis is uncertain since abscesses explored early are sterile but later culture of the pus usually yields Staphylococcus aureus.

Diagnostic Criteria

  • Fever and painful induration/fluctuation of one or more of the large muscles, mostly in the lower limbs.

Investigations

  • FBC
  • ESR

Surgical Treatment: Drain the pus from abscess

Pharmacological Treatment

Adults:
B: Flucloxacillin 250mg + Amoxycillin 250mg PO 6 hourly for 14 days
OR
A: Erythromycin 500 mg PO 6 hourly for 14 days;

Children:
B: 
Cloxacillin25 mg/kg (IV) 6 hourly for 14 days
OR
A: Erythromycin 10 mg/kg 6 hourly for 14 days

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