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Content Update

June 12, 2019

Oral versus Intravenous Antibiotics for Bone and Joint Infection: IV antibiotics have long been considered superior to oral antibiotics for serious infections based on the misconception that IV therapy is “stronger” than oral therapy. A recent randomized trial (“Oral versus Intravenous Antibiotics for Bone and Joint Infection”, or “OVIVIA”) found that oral antibiotic therapy was noninferior to IV antibiotic therapy during the first 6 weeks for complex bone and joint infections. The OVIVA trial may impact standard-of-care for bone and joint infections and lessen (or ultimately eliminate) the need for IV antibiotics for 6 weeks in select patients. Using oral therapy in appropriate patients may lead to decreased length of hospital stay, fewer adverse events, fewer IV-related complications, and overall reduced healthcare costs.

KEY CONCEPTS

KEY CONCEPTS

  • Image not available. The most common cause of osteomyelitis (particularly that acquired by hematogenous spread) and infectious arthritis is Staphylococcus aureus.

  • Image not available. Culture and susceptibility information are essential as a guide for antimicrobial treatment of osteomyelitis and infectious arthritis.

  • Image not available. Joint aspiration and examination of synovial fluid are extremely important to evaluate the possibility of infectious arthritis.

  • Image not available. The most important treatment modality of acute osteomyelitis is the administration of appropriate antibiotics in adequate doses for a sufficient length of time.

  • Image not available. Antibiotics generally are given in high doses so that adequate antimicrobial concentrations are reached within the infected bone and joints.

  • Image not available. Oral antimicrobial therapies can be used for osteomyelitis to follow a parenteral regimen in children who have a good clinical response to IV antibiotics and in adults without diabetes mellitus or peripheral vascular disease when the organism is susceptible to the oral antimicrobial, a suitable oral agent is available, and adherence is ensured.

  • Image not available. The standard duration of antimicrobial treatment for acute osteomyelitis is 4 to 6 weeks.

  • Image not available. The three most important therapeutic approaches to the management of infectious arthritis are appropriate antibiotics, joint drainage, and joint rest.

  • Image not available. Monitoring of antibiotic therapy is important and typically involves noting clinical signs of inflammation, periodic white blood cell (WBC) counts, C-reactive protein, and erythrocyte sedimentation rate (ESR) determinations.

Bone and joint infections are comprised of two disease processes known, respectively, as osteomyelitis and septic or infectious arthritis. They are unique and separate infectious entities with different signs and symptoms and infecting organisms. Despite advances in therapy, these infections continue to cause significant morbidity from residual damage and chronic or recurring infections. Emphasis on initiating antibiotic therapy as soon as possible is important in reducing long-term complications.

EPIDEMIOLOGY

Osteomyelitis

Image not available. Osteomyelitis generally is an uncommon disease. One classic publication reported that 247 patients had osteomyelitis in a prominent American teaching hospital during a 4-year period.1 Acute osteomyelitis has an estimated annual incidence of 0.4 per 1,000 children. In adults, osteomyelitis caused by contiguous spread, including postoperative, direct puncture, and that associated with adjacent soft tissue infections, comprises 47% of infections. ...

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