How should I manage a patient with osteomyelitis who is not responding to oral antibiotics?

Management of osteomyelitis not responding to oral antibiotics:

• Osteomyelitis requires treatment with intravenous antibiotics in secondary care, as oral antibiotics alone may be insufficient for complicated or deep-seated infections.
• First-line intravenous antibiotics generally include teicoplanin or vancomycin, with daptomycin as an alternative option.
• Patients not responding to oral antibiotics should be referred to secondary care for intravenous therapy and specialist assessment.
• The duration of antibiotic treatment is based on clinical assessment and can range from a minimum of 7 days up to 6 weeks, often starting with intravenous antibiotics and switching to oral antibiotics when appropriate.
• Microbiological results should guide antibiotic choice and adjustments, including consideration of resistant organisms such as MRSA.
• Persistent infection despite appropriate therapy warrants thorough evaluation for metastatic infection sites and possible antibiotic resistance, potentially requiring combination therapy or alternative agents.

In summary, a patient with osteomyelitis not responding to oral antibiotics should be managed with intravenous antibiotics in secondary care, using agents such as vancomycin or teicoplanin, with treatment duration tailored to clinical response and microbiological guidance.

NICE NG19,NICE CKS