Antibiosis
Decisive for the antibiotic treatment of osteomyelitis is the detection of the pathogen at the affected site. In any case, a blood test should be performed, and if necessary, a puncture of fluid accumulations and abscesses at the osteomyelitic focus should be performed to determine the pathogen. In the best case, treatment with antibiotics is pathogen-specific, immediate and is administered intravenously.
In the acute inflammatory phase of osteomyelitis, it is crucial that the antibiotic is brought to the site of infection for a sufficiently long time. Furthermore, the concentration of the antibiotic at the site of action must be sufficient to kill the pathogen efficiently. As with any targeted antibiotic, it is important to test for resistance of the pathogen to various antibiotics in the best possible way.
Treatment with the antibiotic clindamycin has been shown to be beneficial because it effectively accumulates in the bone area and a complete cure of the disease can be achieved. Alternatively, an antibiotic treatment with penicillins (e.g. oxacillin, flucloxacillin) or cephalosporins can be used. As a rule, antibiotic therapy can be terminated when the rate of blood cell sedimentation (BSG, non-specific inflammation parameter) normalizes or when there are no symptoms.
Only targeted antibiotics prevent transitions to chronic osteomyelitis. In contrast, chronic osteomyelitis usually requires surgical intervention. As already described under Causes, endogenous – hematogenic osteomyelitis develops due to pathogens that are carried by the blood from a specific site of infection within the body into the bone marrow of a bone.They then settle there, which leads to abscess formation.
Abscesses are foci of pus which the body can intercept if the immune system is very good to good. Then they remain localized, while they often spread when the immune status is poor. As can be seen from this, the course of the disease depends on individual factors, such as the immune defence, but also on the age of the patient.
In children up to the age of two years, blood vessels of the medullary cavity run directly from the metaphysis (= growth zone of the bone) through the cartilaginous epiphysis joint into the pineal gland (= end piece of the bone; transition to the joint). As a result, the pathogens can also penetrate into the joints and cause purulent joint effusions there, which in turn can cause severe joint damage and possibly even growth disorders. With increasing age, the blood supply to the epiphysis joint decreases in childhood and adolescence until it is no longer supplied with blood at all later on.
As a result, the infection of the bone marrow is then usually limited to the metaphysis, so that the joints are usually no longer affected. The hip joint is the exception to the rule, however, since there the metaphysis is included in the joint capsule. Therefore, the joint can also be affected here.
However, as soon as the end of the growth phase is reached, ossification of the cartilaginous components occurs. As a result, the protective boundary to the pineal gland joint is removed again. As a result, infections of the joints can reoccur in adults – similar to children up to two years of age.
In addition to the individually varying course of the disease, the virulence (= aggressiveness) of a pathogen also has an effect on the course of the disease. As a result, one and the same type of pathogen can, under certain circumstances, cause different severe types of the disease. The spectrum then ranges from a mild disease with mild symptoms to acute, sometimes life-threatening symptoms, or the chronic course in chronic osteomyelitis.
There are forms of endogenous – hematogenic osteomyelitis, which often have a chronic course. These are, for example, the so-called Brodie abscess, Paget’s disease or tuberculous osteomyelitis (see definition). Each of these diseases occurs very rarely compared to the other forms, but all of them have an individual clinical picture with very typical, individual disease patterns and courses.
According to scientific studies, endogenous osteomyelitis occurs predominantly in children and adolescents, with a specific incidence in the eighth year of life, usually after a general infection. Mostly the femur or tibia was affected by the disease. On average, boys seem to be affected by the disease more often than girls.
With regard to endogenous osteomyelitis in adulthood, it can be stated that this disease is rather rare. Similar to childhood and adolescence, men are affected more frequently than women. Endogenous hematogenic osteomyelitis in adulthood includes the long tubular bones (e.g. tibia) and the spine.
