Osteomyelitis. A commonsense approach to antibiotic and surgical treatment.

Therapy for osteomyelitis requires a multidisciplinary approach. A precise microbiologic diagnosis and adequate debridement of necrotic tissue are essential. Acute hematogenous osteomyelitis usually responds to antimicrobial therapy. The presence of an abscess or a metaphyseal cavity in hematogenous osteomyelitis and evidence of spinal cord compression in vertebral osteomyelitis require surgical treatment. Chronic osteomyelitis usually implies that dead bone is present, which requires surgical debridement. Because of the chronicity of the infection and various presentations and surgical approaches, antibiotic treatment must be individualized. In general, however, at least 4 weeks of therapy is required.