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 |
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
