Osteomyelitis
Antimicrobial prescribing: NHS Fife
Clinical features
- Pain
- Erythema
- Swelling
- Sinus tract formation
- Fever and systemic upset
Investigations
- Blood culture
- Bone biopsy
Infection Control
Basic universal precautions
Treatment
Source control may be required to achieve a successful outcome, including bone debridement (which also provides samples for culture) – discuss with Orthopaedics
Chronic infection may not require immediate treatment if the patient is otherwise well. Aim to obtain culture samples prior to treatment
Rifampicin has excellent oral bioavailability. IV is not required unless the oral route is compromised
FLUCLOXACILLIN IV 2g 6 hourly
after 48 hours, or after source control Add
RIFAMPICIN PO 450mg 12 hourly
If true penicillin allergy or known MRSA:
VANCOMYCIN IV Dose as per calculator
Target trough 15-20 mg / L
after 48 hours, or after source control Add
RIFAMPICIN PO 450mg 12 hourlyDuration: Discuss with Microbiology