Acute osteomyelitis | Right Decisions

Please update your RDS mobile app to version 4.7.1

We are pleased to advise that deep linking capability, enabling users to directly download individual mobile toolkits, has now been released on the RDS mobile app. When you install the update, you will see that each toolkit has a small QR code icon the header area beside the search icon – see screenshot below. Clicking on this icon will open up a window with a full-size QR code and the alternative of a short URL for sharing with users. Instructions are provided.

You may need to actively install the update to install RDS app version 4.7.1 to see this improvement. Installing this update is also strongly recommended to get the full benefits of the new contingency arrangements – specifically, that if the RDS website should fail, you will still be able to download new mobile app toolkits.

To check your current RDS version, click on the three dots bottom right of the RDS app screen. This takes you to a “More” page where you will see the version number. To install latest updates:

On iPhones – go to the Apple store, click on your profile icon top right, scroll down to see the apps waiting to be updated and update the RDS app.

On Android phones – these can vary, but try going to the Google Play store, click on your profile icon top right, click on “Manage apps and device”, select and update the RDS app.

Please get in touch with ann.wales3@nhs.scot with any questions.

Do not start antibiotic therapy until above obtained and discuss all cases with microbiology and orthopaedics.

See separate guidance for Diabetic foot infections.

Required investigations

Blood cultures x 2 sets (10mls in each bottle)
Bone and tissue samples sent to microbiology for microscopy and culture; these should be obtained by percutaneous biopsy or during surgery. Superficial swabs are discouraged.

Antimicrobial recommendation

Recommended total duration: 6 weeks (Total duration = IV + oral)

First line	Flucloxacillin 2g every 6 hours IV
Penicillin allergy OR previous MRSA colonisation or infection	Vancomycin IV (use NHS Lothian Calculator on AMT intranet page); aim trough levels 15-20mg/L

Notes

Surgical debridement might be required if progression to chronic osteomyelitis is to be avoided.
Within 7 days after surgery (or, if the infection is being managed without surgery, within 7 days after the start of IV antibiotic treatment) IV to oral switch should be considered. Choice of agent depends on microbiology results.
When clinically stable, consider OPAT referral for outpatient IV treatment or monitoring of complex oral treatment regimes.

Likely organisms: Staphylococcus aureus