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8/13/2019 JURINGLINASTK

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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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