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Am Fam Physician. 2021;104(4):online

See related article on osteomyelitis

What is osteomyelitis?

Osteomyelitis (OSS-tee-oh-MY-uh-LIE-tiss) is an infection in a bone. It is caused by bacteria that spread through the blood from a wound or infection somewhere else in the body. In children, it usually occurs in the arms and legs. In adults, it usually affects the feet, spine, or hips. People who smoke or have diabetes, a weak immune system, or poor circulation are more likely to get osteomyelitis.

What are the symptoms?

Children usually have pain, swelling, and redness over the infected area. They may have a fever or trouble moving the affected arm or leg. They may be more tired than usual. Adults may have a fever or feel tired. They may have pain in the area over the bone, and wounds that take longer to heal. Symptoms may take weeks to develop after the infection has started.

How is it diagnosed?

In children, osteomyelitis is usually diagnosed by the symptoms and a physical exam. In adults, diagnosis can be harder because the symptoms and exam are not always clear. Blood tests can show an infection in the body. Other tests that take pictures of the inside of your body, such as x-rays or magnetic resonance imaging (MRI), must also be done. The best way to tell if a patient has osteomyelitis is to remove a piece of damaged bone and test it for bacteria.

How is it treated?

The main treatment for children and adults is antibiotics (medicines that fight bacteria). Antibiotics are usually given through an IV (a needle inserted in the skin) to get high doses of medicine into the blood. Then, antibiotic pills may be used. Children usually need about four weeks of antibiotics. Adults may need to take antibiotics for six to eight weeks. Sometimes surgery is needed to clean out the infected bone.

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