Diagnosis and treatment of osteomyelitis

The diagnosis and management of osteomyelitis continues to present problems. Technetium bone scans may identify acute osteomyelitis before the characteristic disease changes are visible on x-ray studies, but they have a number of drawbacks. Microbiological studies are critical in making precise diagnoses of the cause so that proper therapy will be given. In treatment of acute osteomyelitis, several investigators report good results from four-week administration of parenteral antibiotic, or one week of parenteral treatment followed by three weeks of oral therapy. Chronic osteomyelitis requires surgical removal of dead tissue followed by lengthy parenteral and oral antibiotic therapy. Chronic forms of the disease caused by resistant gram-negative organisms may prove responsive to quinoline therapy. These agents may attain inhibitory levels on oral administration, and have proved to be effective in animal models. Clinical trials, however, are required to determine their usefulness in the treatment of clinical disease.