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Article

Management of Acute Osteomyelitis: A Ten-Year Experience

Divisions of Pediatric Infectious Diseases, University of Michigan and University of Toledo; Office for Health Equity and Inclusion, University of Michigan Medical School, USA
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Author to whom correspondence should be addressed.
Infect. Dis. Rep. 2016, 8(3), 6350; https://0-doi-org.brum.beds.ac.uk/10.4081/idr.2016.6350
Submission received: 4 December 2015 / Revised: 4 December 2015 / Accepted: 1 June 2016 / Published: 29 September 2016

Abstract

Osteomyelitis is an infection of the bone; proper management requires prolonged antibiotic treatment. Controversy exists as to when a patient should transition from intravenous to oral antibiotics. However, due to the high bioavailability of some oral antibiotics, optimal time to transition from high to low bioavailability antibiotics is a more valid consideration. Additionally, there are questions surrounding the efficacy of certain antibiotics, specifically trimethoprim-sulfamethoxazole (TMP-SMX), in treating osteomyelitis. After obtaining Institutional Review Board approval from both universities, a retrospective chart review was conducted, utilizing an author-created severity scale, on all patients seen by Pediatric Infectious Diseases at the Universities of Michigan and Toledo with an acute osteomyelitis diagnosis from 2002-2012. There were 133 patients, 106 treated successfully. Success was defined in this study specifically as treatment of <14 weeks without recurrence within 30 days of stopping antibiotics or permanent site disability. Seventeen patients were treated with TMP-SMX at comparable cure rates. Patients with pre-existing bone defects (noted in radiological reports), initial erythrocyte sedimentation rate (ESR) ≥70, hematogenous osteomyelitis with soft tissue extension, and skull osteomyelitis were associated with increased failure rate. Switch to low bioavailability antibiotics occurred, on average, at 3.5 weeks; however, switching before then was not associated with decreased cure rate. As prevalence of methicillin-resistant Staphylococcus aureus (MRSA), especially clindamycin- resistant MRSA, increases, TMP-SMX appears to be an acceptable antibiotic. There does not appear to be a minimum length of high bioavailability treatment required for cure. Prior bone defect, extensive infection, ESR≥70, or skull osteomyelitis may be indications for more aggressive management.
Keywords: Acute osteomyelitis; trimethoprimsulfamethoxazole; bioavailability; debridement; ESR Acute osteomyelitis; trimethoprimsulfamethoxazole; bioavailability; debridement; ESR

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MDPI and ACS Style

Helm, C.; Huschart, E.; Kaul, R.; Bhumbra, S.; Blackwood, R.A.; Mukundan, D. Management of Acute Osteomyelitis: A Ten-Year Experience. Infect. Dis. Rep. 2016, 8, 6350. https://0-doi-org.brum.beds.ac.uk/10.4081/idr.2016.6350

AMA Style

Helm C, Huschart E, Kaul R, Bhumbra S, Blackwood RA, Mukundan D. Management of Acute Osteomyelitis: A Ten-Year Experience. Infectious Disease Reports. 2016; 8(3):6350. https://0-doi-org.brum.beds.ac.uk/10.4081/idr.2016.6350

Chicago/Turabian Style

Helm, Caitlin, Emily Huschart, Rajat Kaul, Samina Bhumbra, R. Alexander Blackwood, and Deepa Mukundan. 2016. "Management of Acute Osteomyelitis: A Ten-Year Experience" Infectious Disease Reports 8, no. 3: 6350. https://0-doi-org.brum.beds.ac.uk/10.4081/idr.2016.6350

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