Transcript
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DRUG THERAPY IN OSTEOMYELITIS
SITI KARLINA
FACULTY OF MEDICINE AND HEALTH SCIENCEMUHAMMADIYAH YOGYAKARTA UNIVERSITY
Maryam Nadeem et al, 2010
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ABSTRACT
Osteomyelitis (OM) is a progressive infection of thebone marrow and cortex resulting in inflammatory
destruction of the bone.
Disease prevalence is higher in men than women,
and it is more often seen in children and people over50.
Dramatic changes in therapy include new antibiotics,
new surgical techniques and parenteral antimicrobial
therapy.
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INTRODUCTION
The words Osteomyelitis is derived from two wordsosteon (bone) and myelo (marrow) which are
combined with itis (inflammation) to define the
clinical state in which bone is infected with micro
organisms.
Children who suffer from osteomyelitis are often
affected in the femur, or upper leg bone, or the lower
leg bone (the tibia) as well as the bones found in thearm.
Adults who suffer from osteomyelitis most often
suffer the bone infection in the pelvis or the spine.
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PHATOGENESIS
Whatever the source of infection, once an organism reaches the bone it causes
acute inflammation. Bacteria have various different mechanisms to facilitate cell-cell
and cellimplant adhesion.
During acute infection, phagocytes attempt to contain invading microorganisms and,in the process, generate toxic oxygen radicals and release proteolytic enzymes that
may lyse the surrounding tissues.
Pus resulting from inflammatory response spreads into vascular channels, raising the
intraosseous pressure and impairing blood flow. With the progression to a chronic
state, the ischemic necrosis of bone results in the separation of devascularized
fragments, which are called sequestrum.
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CLASSIFICATION
Tabel 1.
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STAGING SYSTEM
Table 2. (Cierny Mader Staging System)
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Joint in neonates patients with sickle celldisease and those with nail puncture wounds.
The older patiens with TB.
Open fractures of the tibia and ankle arecommon in motor vehicle accidents and are
particularly prone to the development of
osteomyelitis.
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DIAGNOSIS OF OSTEOMYELITIS
CLINICAL FEATURES
Children and adults with hematogenousosteomyelitis may present with acute signs of
infection including pain of limb involved, fever,
irritability, lethargy, and local signs of
inflammation.
Patients with contiguous focus osteomyelitis
often present with localized bone and jointpain, erythema, swelling, and drainage around
the area of trauma, surgery, or wound infection.
LABORATORY FINDINGS
Leukocyte acute osteomyelitis, Normal in chronic
cases
Erythrocyte (acute& chronic) after successful
treatment.
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DIAGNOSTIC EVALUATION
X-RAY
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The successful outcome depends on early diagnosisand prompt, adequate therapy.
The principles of treatment are symptomatic
measures, bedrest and operative intervention, if
necessary, with drainage of pus and debridement of
any necrotic material, together with antibiotic
treatment in sufficient concentration and for
sufficient duration. The goal of treatment is to prevent complications.
MANAGEMENT
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TREATMENT
ANTIBIOTIC
Decisions about antibioticsClinical information, laboratoryand microbiology information, ease of administration,
patient compliance, potential adverse effects, cost, local
resistance patterns and available evidence supporting
various treatment options. Antibiotic classes : Penicillins, Betalactamase inhibitors,
Cephalosporins, other Beta-lactams (aztreonam&imipenem),
vancomycin, clindamycin, rifampin, aminoglycosides,
fluoroquinolones, trimethoprim-sulfamethoxazole,
metronidazole, and new investigational agents (Teicoplanin,
Quinupristin/Dalfopristin, and Oxazolidinones).
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Osteomyelitis (OM) remains challenging andexpensive to treat, despite advances in antibiotics
and new operative techniques.
Drugs are the only part of the overall treatment for
patients with OM and all patients require a holisticapproach to OM assessment and management.
Antimicrobial treatment often involves a
combination of antibiotics and the decision to use
oral or parenteral antibiotics should be based on
results regarding microorganism sensitivity, patient
compliance, infectious disease consultation, and the
surgeonsexperience.
CONCLUSION
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