Abstract
The principles of osteomyelitis therapy of the jaws are focus eradication by meticulous debridement including removal of dead bone and unstable internal fixation devices, combined with correct empirical and adequate antimicrobials. The most frequent microorganisms are viridans streptococci, peptostreptococci, Eikenella corrodens, Fusobacterium spp., and Actinomyces spp. In case of implant-associated osteomyelitis, S. aureus and coagulase- negative staphylococci are the most important infecting agents. Accordingly, empirical therapy should include the spectrum of these microorganisms. This is the case for amoxicillin/clavulanic acid or clindamycin. Acute osteomyelitis of neonates and young infants should be treated by the i.v. route for the first couple of days, followed by a 3- to 6-week oral treatment course. Acute osteomyelitis associated with trauma or fracture is treated for 6 weeks in the absence, and for 3 months in the presence, of an internal fixation device. In implant- associated staphylococcal infection, a rifampin combination, mostly a quinolone, should be preferred. In secondary chronic osteomyelitis therapy includes meticulous debridement surgery and long-term antibiotic therapy. Acute odontogenic and post-extraction osteomyelitis is sometimes caused by Actinomyces spp. These microorganisms are difficult to detect; therefore, biopsies instead of swabs are required, and the laboratory needs to be notified when submitting samples for culture. The duration of therapy is longer in actinomycosis, namely not only 4−6 weeks as in other types of osteomyelitis, but at least 6 months. True osteomyelitis arising from periimplantitis is rare despite exposure of the dental implants to the mouth flora and periodontal pathogens and must be treated by removal of the implant and eradication of necrotic bone tissue. The therapy of primary chronic osteomyelitis remains controversial since the etiology and pathogenesis of this rare disease are not yet understood. A bacterial cause is discussed by some authors but has not been proven; hence, the role of antibiotic therapy in these cases is unclear.
Access provided by Autonomous University of Puebla. Download to read the full chapter text
Chapter PDF
Similar content being viewed by others
Keywords
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
References
Adekeye EO, Cornah J. Osteomyelitis of the jaws: a review of 141 cases. Br J Oral Maxillofac Surg 1985; 23:24–35
Andriole V. The quinolones:past, present, and future. Clin Infect Dis 2005; 41:113–119
Badros A, Weikel D, Salama A, Goloubeva O, Schneider A, Rapoport A, Fenton R, Gahres N, Sausville E, Ord R, Meiller T. Osteonecrosis of the jaw in multiple myeloma patients: clinical features and risk factors. J Clin Oncol 2006; 24(6):945–952
Baker KA, Fotos PG. The management of odontogenic infections. A rationale for appropriate chemotherapy. Dent Clin North Am 1994; 38:689–706
Baltensperger M, Gratz K, Buder E, Lebeda R, Makek M, Eyrich G. Is primary chronic osteomyelitis a uniform disease? Proposal of a classification based on a retrospective analysis of patients treated in the past 30 years. J Craniomaxillofac Surg 2004; 32:43–50
Bar T, Mishal J, Lewkowicz A, Nahlieli O. Osteomyelitis of the mandible due to Mycobacterium abscessus: a case report. J Oral Maxillofac Surg 2005; 63:841–844
Bartkowski SB, Zapala J, Heczko P, Szuta M. Actinomycotic osteomyelitis of the mandible: review of 15 cases. J Craniomaxillofac Surg 1998; 26:63–67
Bhatt, A, Jayakrishnan A. Tuberculous osteomyelitis of the mandible: a case report. Int J Paediatr Dent 2001; 11:304–308
Carr A, Cole W, Roberton D, Chow C. Chronic multifocal osteomyelitis. J Bone Joint Surg (Br) 1993; 75:582–91
Ciampolini J, Harding KG. Pathophysiology of chronic bacterial osteomyelitis. Why do antibiotics fail so often? Postgrad Med J 2000; 76:479–483
Darley ES, MacGowan AP. Antibiotic treatment of Gram-positive bone and joint infections. J Antimicrob Chemother 2004; 53:928–935
Darouiche RO. Device-associated infections: a macro problem that starts with micro-adherence. Clin Infect Dis 2001, 33:1567–1572
Davis JS. Management of bone and joint infections due to Staphylococcus aureus. Intern Med J 2005; 35(Suppl 2):S79–S96
Dimitrakopoulos I, Lazaridis N, Asimaki A. Craniofacial invasive aspergillosis in an immunocompetent patient: a case report. J Oral Maxillofac Surg 2005, 63:845–848
Drancourt M, Stein A, Argenson JN, Zannier A, Curvale G, Raoult D. Oral rifampin plus ofloxacin for treatment of Staphylococcus-infected orthopedic implants. Antimicrob Agents Chemother 1993, 37:1214–1218
Edelstein H, Chirurgi VA, Hybarger CP. Osteomyelitis of the jaw in patients infected with the human immunodeficiency virus. South Med J 1993; 86:1215–1218
Ertas U, Tozoglu S, Gursan N. Chronic osteomyelitis: 20 years after mandible fracture. Dent Traumatol 2004; 20:106–108
Eyrich G, Harder C, Sailer H, Langenegger T, Bruder E, Michel B. Primary chronic osteomyelitis associated with synovitis, acne, pustulosis, hyperostosis and osteitis (SAPHO syndrome). J Oral Pathol Med 1999; 28:456–464
Eyrich G, Baltensperger M, Bruder E, Graetz K. Primary chronic osteomyelitis in childhood and adolescence: a retrospective analysis of 11 cases and review of the literature. J Oral Maxillofac Surg 2003; 61(5):561–573
Farnam J, Griffin JE, Schow CE, Mader J, Grant JA. Recurrent diffuse osteomyelitis involving the mandible. Oral Surg Oral Med Oral Pathol. 1984; 57:374–378
Fluckiger U, Zimmerli W. Diagnosis and follow-up management of postoperative bacterial osteitis. Orthopade 2004; 33:416–423 [in German]
Flygare L, Norderyd J, Kubista J, Ohlsson J, Vallo-Christiansen J, Magnusson B. Chronic recurrent multifocal osteomyelitis involving both jaws: report of a case including magnetic resonance correlation. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1997; 83:300–305
Fux CA, Costerton JW, Stewart PS, Stoodley P. Survival strategies of infectious biofilms. Trends Microbiol 2005; 13:34–40
Gristina AG, Oga M, Webb LX, Hobgood CD. Adherent bacterial colonization in the pathogenesis of osteomyelitis. Science 1985; 228:990–993
Hovi L, Saarinen UM, Donner U, Lindqvist C. Opportunistic osteomyelitis in the jaws of children on immunosuppressive chemotherapy. J Pediatr Hematol Oncol 1996; 18:90–94
Hudson JW. Osteomyelitis of the jaws: a 50-year perspective. J Oral Maxillofac Surg 1993; 51(12):1294–1301
Jacobsson S, Hollender L. Treatment and prognosis of diffuse sclerosing osteomyelitis (DSO) of the mandible. Oral Surg Oral Med Oral Pathol 1980; 49(1):7–14
Kim SG, Jang HS. Treatment of chronic osteomyelitis in Korea. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2001; 92(4):394–398
Klinge B, Gustafsson A, Berglundh T. A systematic review of the effect of anti-infective therapy in the treatment of peri-implantitis. J Clin Periodontol 2002; 29(Suppl 3):213–225; discussion 232–233
Koorbusch GF, Fotos P, Goll KT. Retrospective assessment of osteomyelitis. Etiology, demographics, risk factors, and management in 35 cases. Oral Surg Oral Med Oral Pathol 1992; 74(2):149–154
Kuehnel TS, Schurr C, Lotter K, Kees F. Penetration of telithromycin into the nasal mucosa and ethmoid bone of patients undergoing rhinosurgery for chronic sinusitis. J Antimicrob Chemother 2005; 55:591–594
Leonhardt A, Dahlen G, Renvert S. Five-year clinical, microbiological, and radiological outcome following treatment of periimplantitis in man. J Periodontol 2003; 74:1415–1422
Lew DP, Waldvogel FA. Osteomyelitis. N Engl J Med 1997; 336:999–1007
Lew DP, Waldvogel FA. Osteomyelitis. Lancet 2004; 364:369–379
Loh FC, Ling SY. Acute osteomyelitis of the maxilla in the newborn. J Laryngol Otol 1993; 107:627–628
Marx RE. Chronic osteomyelitis of the jaws. Oral Maxillofac Surg Clin North Am 1991; 3(2):367–381
Marx RE, Carlson ER, Smith BR, Toraya N. Isolation of Actinomyces species and Eikenella corrodens from patients with chronic diffuse sclerosing osteomyelitis. J Oral Maxillofac Surg 1994; 52(1):26–34
Mombelli A, Lang N. Antimicrobial treatment of peri-implant infections. Clin Oral Implants Res 1992; 3:162–168
Murry A. For how long should osteomyelitis be treated? In: Armstrong D, Cohen J (eds) Infectious diseases, 2nd edn. Harcourt, London, 2005, pp 607–609
Nagler R, Peled M, Laufer D. Cervicofacial actinomycosis:a diagnostic challenge. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1997; 83:652–656
Nelson JD. Skeletal infections in children. Adv Pediatr Infect Dis 1991; 6:59–78
Norden CW. Lessons learned from animal models of osteomyelitis. Infect Dis 1988; 10:103–110
Norden CW, Fierer J, Bryant RE. Chronic staphylococcal osteomyelitis: treatment with regimens containing rifampin. Rev Infect Dis 1983; 5(Suppl 3):S495–S501
Norden CW, Shinners E, Niederriter K. Clindamycin treatment of experimental chronic osteomyelitis due to Staphylococcus aureus. J Infect Dis 1986; 153:956–959
Ortqvist A, Hammers-Berggren S, Kalin M. Respiratory tract colonization and incidence of secondary infection during hospital treatment of community-acquired pneumonia. Eur J Clin Microbiol Infect Dis 1990; 9:725–731
Robinson JL, Vaudry WL, Dobrovolsky W. Actinomycosis presenting as osteomyelitis in the pediatric population. Pediatr Infect Dis J 2005; 24:365–369
Roos-Jansaker AM, Renvert S, Egelberg J. Treatment of peri-implant infections: a literature review. J Clin Periodontol 2003; 30:467–485
Sanchez-Garces MA, Gay-Escoda C. Periimplantitis. Med Oral Patol Oral Cir Bucal 2004; 9(Suppl 69–74):63–69
Schaad UB. Fluoroquinolone antibiotics in infants and children. Infect Dis Clin North Am 2005; 19:617–628
Schou S, Berglundh T, Lang NP. Surgical treatment of peri-implantitis. Int J Oral Maxillofac Implants 2004; 19 (Suppl):140–149
Sieber OF, Larter W, Smith PJ, Crowe P Jr, Pitt M. Coccidioides immitis osteomyelitis of the mandible in an infant. J Oral Surg 1977; 35:721–725
Smego RA Jr, Foglia G. Actinomycosis. Clin Infect Dis 1998; 26:1255–1261
Steer AC, Carapetis JR. Acute hematogenous osteomyelitis in children: recognition and management. Paediatr Drugs 2004; 6:333–346
Stewart PS. Mechanisms of antibiotic resistance in bacterial biofilms. Int J Med Microbiol 2002; 292:107–113
Stewart PS Costerton JW. Antibiotic resistance of bacteria in biofilms. Lancet 2001; 358:135–138
Taher AA. Osteomyelitis of the mandible in Tehran, Iran. Analysis of 88 cases. Oral Surg Oral Med Oral Pathol 1993; 76(1):28–31
Tanner A, Maiden MF, Lee K, Shulman LB, Weber HP. Dental implant infections. Clin Infect Dis 1997; 25 (Suppl 2):S213–S217
Trampuz A, Zimmerli W. Prosthetic joint infections: update in diagnosis and treatment. Swiss Med Wkly 2005; 135:243–251
Trampuz A, Zimmerli W. Antimicrobial agents in orthopedic surgery: prophylaxis and treatment. Drugs 2006a; 66(8):1089–1105
Trampuz A, Zimmerli W. Diagnosis and treatment of infections associated with fracture-fixation devices. Injury 2006b; 37:S59–S66
Wetzel A, Vlassis J, Caffesse R, Hammerle C, Lang N. Attempts to obtain re-osseointegration following experimental peri-implantitis in dogs. Clin Oral Implants Res 1999; 10:111–119
Widmer A, Barraud GE, Zimmerli W. Reaktivierung einer Staphylococcus aureus osteomyelitis nach 49 Jahren. Schweiz Med Wschr 1988; 118:23–26
Widmer A, Frei R, Rajacic Z, Zimmerli W. Correlation between in vivo and in vitro efficacy of antimicrobial agents against foreign body infections. J Infect Dis 1990; 162:96–102
Widmer A, Wiestner A, Frei R, Zimmerli W. Killing of nongrowing and adherent Escherichia coli determines drug efficacy in device-related infections. Antimicrob Agents Chemother 1991; 35:741–746
Xue IB, Davey PG, Phillips G. Variation in postantibiotic effect of clindamycin against clinical isolates of Staphylococcus aureus and implications for dosing of patients with osteomyelitis. Antimicrob Agents Chemother 1996; 40:1403–1407
Zimmerli W, Ochsner P. Management of orthopedic implant associated infections. Infection 2003; 31:99–108
Zimmerli W, Frei R, Widmer A, Rajacic Z. Microbiological tests to predict treatment outcome in experimental device-related infections due to Staphylococcus aureus J Antimicrob Chemother 1994; 33:959–967
Zimmerli W, Widmer AF, Blatter M, Frei R, Ochsner PE. Role of rifampin for treatment of orthopedic implant-related staphylococcal infections: a randomized controlled trial. Foreign-Body Infection (FBI) Study Group. J Am Med Assoc 1998; 279:1537–1541
Zimmerli W, Trampuz A, Ochsner PE. Prosthetic-joint infections. N Engl J Med 2004; 351:1645–1654
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2009 Springer-Verlag Berlin Heidelberg
About this chapter
Cite this chapter
Zimmerli, W. (2009). Osteomyelitis Therapy – Antibiotic Therapy. In: Baltensperger, M., Eyrich, G. (eds) Osteomyelitis of the Jaws. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-28766-7_9
Download citation
DOI: https://doi.org/10.1007/978-3-540-28766-7_9
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-540-28764-3
Online ISBN: 978-3-540-28766-7
eBook Packages: MedicineMedicine (R0)