Medicines for Osteomyelitis

What it is

Osteomyelitis is an infection of a bone. It is usually caused by bacteria, which can reach the bone in several ways: spreading through the bloodstream from an infection elsewhere in the body; spreading from a nearby infection or wound; or entering directly, for example after an injury (such as an open fracture where bone is exposed) or surgery. It can affect people of any age — in children it more often affects the long bones of the arms or legs, while in adults it more commonly affects the spine, and it can also affect other bones, including the feet (particularly in people with diabetes). Certain groups are at higher risk, including people with diabetes, poor circulation, a weakened immune system, recent bone injury or surgery, or those who inject drugs. The symptoms of osteomyelitis can include: pain in the affected bone, which may be severe; tenderness, warmth, redness, and swelling over the area; a high temperature and feeling generally unwell; reduced use of the affected limb or reluctance to move it or bear weight (particularly noticeable in children); and, in longer-standing (chronic) cases, ongoing pain, a discharging wound or sinus, or recurring problems. Osteomyelitis needs prompt medical treatment, because if a bone infection is not treated effectively, it can cause lasting damage to the bone and lead to complications. Treatment usually involves a course of antibiotics (often started into a vein and continued for a prolonged period), and, in some cases, surgery to drain infection or remove dead or infected bone. With prompt and appropriate treatment, many people recover well, though chronic or complicated cases can be more difficult to treat. The key messages are that bone pain with fever and feeling unwell (particularly in those at higher risk, or in a child who will not use a limb) needs prompt assessment, and that osteomyelitis is treated with antibiotics and sometimes surgery.

How it is treated

Osteomyelitis needs prompt medical assessment and treatment, usually with antibiotics and sometimes surgery, to clear the infection and prevent lasting bone damage. If a bone infection is suspected — bone pain with warmth, swelling, and redness over the area, a fever, and feeling unwell, particularly in someone at higher risk (such as with diabetes, a recent bone injury or surgery, or a weakened immune system), or a child who is reluctant to use or bear weight on a limb — medical assessment is needed promptly. Diagnosis involves examination, blood tests (which may show signs of infection), imaging (such as X-rays, MRI, or bone scans, which can show the bone infection), and often tests to identify the bacteria (for example blood cultures, or a sample from the bone). The mainstay of treatment is antibiotics to clear the infection, which are often started into a vein, especially for more significant infections, and usually continued for a prolonged course (sometimes several weeks), tailored to the bacteria identified. In many cases, surgery is also needed — for example to drain a collection of pus, to remove dead or infected bone (debridement) so that healing can occur, or to deal with a source of infection or associated problem (such as in an infected wound or after surgery involving metalwork). Treating any underlying or contributing factors — such as managing diabetes, caring for foot wounds (particularly important in people with diabetes), or addressing poor circulation — is part of care. With prompt and appropriate treatment, many people recover well, though chronic (long-standing) osteomyelitis, or infections involving implants or poor circulation, can be more difficult to treat and may need prolonged or repeated treatment. Because prompt treatment improves the outcome and reduces the risk of lasting damage, the key messages are to seek assessment for bone pain with fever and feeling unwell (especially in those at higher risk), and, for people with diabetes, to take foot problems seriously and seek care promptly. The reassuring message is that osteomyelitis is treatable — with antibiotics and, where needed, surgery — and that many people recover well with prompt, appropriate treatment.