This is infection of bone. It is a blood-borne infection, usually in children, from a septic focus or following trauma but direct infection of the bone may also occur in fractured bones that communicate with the exterior (i.e. compound fractures). It may be acute or chronic. It is common in patients with sickle cell disease.
CAUSES
Staphylococcus aureus is the commonest organism. Less common organisms include Streptococci, E. coli, Proteus and Pseudomonas and Haemophilus influenzae in children. In sickle cell disease Streptococcus and Salmonella are common causes.
SYMPTOMS
In acute osteomyelitis the patient, usually a child
• has a high fever, 38°C or more
• has pain of the affected part
• is unwilling to move the affected part
SIGNS
• Limited voluntary movement of affected part
• Local swelling, warmth and tenderness
• A definite fluctuant abscess may develop
• Anaemia is severe in patients with sickle cell disease
INVESTIGATIONS
• Full blood count, ESR
• X-ray of the affected bone may be normal initially but new bone formation in the line of the elevated periosteum is seen after 10 to 14 days
• Blood culture or pus for culture if possible
TREATMENT
Therapeutic objectives
• To relieve pain
• To control infection
• To lower body temperature
• To prevent complications e.g. pathological fractures, chronic osteomyelitis
Non-Pharmacological Treatment
• Splintage of affected limb in Plaster of Paris (POP) back slab or other suitable splint
• Tepid sponging
Pharmacological Treatment
(Evidence rating: C)
• IV fluids and blood transfusion if indicated
• Antipyretics/Analgesics.e.g. Paracetamol, oral,
Adults: |
500 mg-1 g 3-4 times a day. |
Children: |
|
3 months-1 year; |
60-120 mg 3-4 times daily |
1-5 years; |
120-250 mg 3-4 times daily |
6-12 years; |
250-500 mg 3-4 times daily |
• Antibiotics
Adults: |
Flucloxacillin, IV, 250-500 mg 6 hourly until the organism and its sensitivities are known. Give parenteral treatment for 2 weeks and then continue with Flucloxacillin oral for 4 weeks. |
Children: |
|
<1 year; |
62.5 mg six hourly |
1-5 years; |
125-250 mg six hourly |
6-12 years; |
250-500 mg six hourly |
Alternative treatment is Clindamycin, oral, IM or IV,
Adults: |
150-300 mg 6 hourly |
Children: |
3-6 mg/kg BW 6 hourly |
Use parenteral route for 2 weeks and then continue with oral for 4 weeks.
In sickle cell disease patients:
Ciprofloxacin, oral, 500-750 mg 12 hourly or IV 200-400 mg 12 hourly should be added to flucloxacillin.
REFER
Refer patients with the following problems to an orthopaedic surgeon;
• Patients not responding to treatment (persistent fever and pain after 2 days)
• Fluctuant abscess will require drainage
• Complications e.g. pathological fracture, chronic osteomyelitis
