Antimicrobial treatment of osteomyelitis.

Parenteral antibiotic therapy remains the mainstay of antimicrobial therapy for osteomyelitis. In acute cases, empirical treatment may be used initially, but antibiotic selection should ideally be based on deep aspiration or bone cultures with corresponding in vitro sensitivity testing. The drug exhibiting the highest bacteriocidal activity with the least toxicity and lowest cost should be chosen. Antibiotic treatment will not substitute for surgical debridement of infected devitalized bone. The length of treatment with parenteral therapy remains controversial. The six-week benchmark, which was determined largely by experience with childhood hematogenous osteomyelitis, may not be applicable to contiguous focus osteomyelitis after trauma in adults. The goal of surgical treatment is to convert an infection with dead bone to a situation with well-vascularized tissues that are readily penetrated by blood-borne antibiotics, making prolonged drug treatment unnecessary.