Osteomyelitis. Common causes and treatment recommendations.

Infections involving bone continue to be a common problem. In children this is usually an acute haematogenous osteomyelitis. Early diagnosis with culture of an aspiration specimen is of paramount importance. Treatment with antibacterial agents is often successful unless pus is obtained in aspiration. In cases with an established abscess, surgical drainage is often needed in addition to antibiotic treatment. Staphylococcus aureus is the most common causative organism, although other microbes are often found in special circumstances such as in neonates, patients with sickle cell disease and those with nail puncture wounds. In adults, a pyogenic osteomyelitis is often due to direct trauma and generally is chronic in nature. Surgical debridement is the mainstay of treatment in these cases. Antibiotic treatment is often helpful but not curative by itself. Fungal and mycobacterial osteomyelitis is especially common in immunocompromised hosts. Amphotericin B remains the preferred treatment for fungal infections. Long term antituberculous multiple drug therapy is often sufficient to treat mycobacterial osteomyelitis.