Osteomyelitis Therapy – Antibiotic Therapy

Abstract

The principles of osteomyelitis therapy of the jaws are focus eradication by meticulous debridement including removal of dead bone and unstable internal fixation devices, combined with correct empirical and adequate antimicrobials. The most frequent microorganisms are viridans streptococci, peptostreptococci, Eikenella corrodens, Fusobacterium spp., and Actinomyces spp. In case of implant-associated osteomyelitis, S. aureus and coagulase- negative staphylococci are the most important infecting agents. Accordingly, empirical therapy should include the spectrum of these microorganisms. This is the case for amoxicillin/clavulanic acid or clindamycin. Acute osteomyelitis of neonates and young infants should be treated by the i.v. route for the first couple of days, followed by a 3- to 6-week oral treatment course. Acute osteomyelitis associated with trauma or fracture is treated for 6 weeks in the absence, and for 3 months in the presence, of an internal fixation device. In implant- associated staphylococcal infection, a rifampin combination, mostly a quinolone, should be preferred. In secondary chronic osteomyelitis therapy includes meticulous debridement surgery and long-term antibiotic therapy. Acute odontogenic and post-extraction osteomyelitis is sometimes caused by Actinomyces spp. These microorganisms are difficult to detect; therefore, biopsies instead of swabs are required, and the laboratory needs to be notified when submitting samples for culture. The duration of therapy is longer in actinomycosis, namely not only 4−6 weeks as in other types of osteomyelitis, but at least 6 months. True osteomyelitis arising from periimplantitis is rare despite exposure of the dental implants to the mouth flora and periodontal pathogens and must be treated by removal of the implant and eradication of necrotic bone tissue. The therapy of primary chronic osteomyelitis remains controversial since the etiology and pathogenesis of this rare disease are not yet understood. A bacterial cause is discussed by some authors but has not been proven; hence, the role of antibiotic therapy in these cases is unclear.