EMERGENCY HOSPITAL ADMISSION AND PARENTERAL ANTIBIOTIC THERAPY (SURGICAL & ID REFERRAL)
Arrange immediate emergency hospital admission to orthopaedics or infectious diseases. Get blood cultures and imaging FIRST. In a haemodynamically stable patient with a normal neurological examination, hold antibiotics until there is a microbiological diagnosis - IDSA recommendation 24. Treat blind only if the patient is unstable: sepsis, or a progressing neurological deficit. Surgical debridement or drainage as indicated - Immediate emergency referral; 6 weeks of parenteral or highly bioavailable oral therapy for most patients, 3 months for Brucella
Immediate emergency admission to pediatric orthopedics for parenteral antibiotic therapy and surgical drainage of subperiosteal abscess if present.
2015 IDSA Clinical Practice Guidelines for the Diagnosis and Treatment of Native Vertebral Osteomyelitis in Adults
Acute osteomyelitis is a surgical and medical emergency requiring urgent hospital admission, bone biopsy/cultures, parenteral high-dose antibiotics, and potential surgical debridement.
- Do not start antibiotics before cultures in a stable patient. A blind start sterilises the cultures and leaves months of treatment aimed at a guess. The exception is the unstable patient, where the delay costs more than the culture.
- TIME-CRITICAL EMERGENCY: Primary care physicians must refer immediately for inpatient management; delay risks chronic osteomyelitis, permanent limb disability, pathological fracture, and sepsis.
- Do not attempt outpatient oral antibiotic monotherapy without hospital evaluation and microbiological diagnosis.
- In diabetic foot osteomyelitis or open fractures, empiric regimen must cover polymicrobial Gram-negative and anaerobic pathogens.
- The guideline this is drawn from covers native vertebral osteomyelitis in adults. Long-bone disease, prosthetic joints and children are outside its scope.
- What the hospital will start once cultures are taken, for the call ahead: ceftriaxone 2 g IV daily plus vancomycin 15-20 mg/kg IV every 12 hours, or cefazolin or flucloxacillin where the organism allows.