From the Guidelines
Discitis treatment should involve 6 weeks of antibiotic treatment, as this duration has been shown to be noninferior to 12 weeks in patients with native vertebral osteomyelitis 1.
Treatment Approach
The initial approach should include empiric broad-spectrum antibiotics that cover Staphylococcus aureus, the most common causative organism.
- The recommended regimen typically includes vancomycin (15-20 mg/kg IV every 12 hours) plus a third-generation cephalosporin like ceftriaxone (2g IV daily).
- This regimen should be adjusted based on blood culture results or tissue samples obtained through image-guided biopsy.
Treatment Duration and Monitoring
- Treatment duration is typically 6 weeks of intravenous antibiotics, potentially followed by 2-3 months of oral antibiotics depending on clinical response 1.
- Pain management is essential and may include NSAIDs, muscle relaxants, and sometimes opioids for severe pain.
- Bed rest is initially recommended, followed by gradual mobilization with appropriate bracing to stabilize the spine.
- Regular monitoring with inflammatory markers (ESR, CRP) and follow-up imaging helps assess treatment response.
Surgical Intervention
- Surgical intervention is reserved for cases with neurological deficits, spinal instability, significant abscess formation, or failure of conservative treatment 1.
- Immobilization, minimally invasive procedures, and surgical debridement are options that can be valuable in the management of vertebral infections, considering the nature and extent of the infection, symptoms, patient’s comorbidities, and the experience of the surgeon. Discitis requires aggressive treatment because the avascular nature of intervertebral discs makes infection difficult to eradicate, and untreated infection can lead to vertebral collapse and neurological complications.
From the Research
Discitis Treatment Overview
- Discitis, also known as septic discitis, is a rare but important cause of spinal pain caused by intervertebral disc infection 2.
- The incidence of septic discitis is 2 per 100,000 per year, with patients presenting with spinal pain, fever, and raised inflammatory markers 2.
Treatment Approaches
- Treatment is most often with intravenous flucloxacillin or ceftriaxone 2.
- CT-guided sampling for culture before commencing antibiotics can increase organism detection and reduce antibiotic course duration 2.
- Six weeks of intravenous followed by 6 weeks of oral therapy is often suggested as treatment, although some recommend using inflammatory markers to guide antibiotic duration 2.
- Vancomycin is currently the gold standard treatment for medical management of methicillin-resistant Staphylococcus aureus (MRSA) discitis, with linezolid being a clinically attractive alternative due to its mild side effect profile and oral bioavailability 3.
Management Recommendations
- Conservative therapy, based on targeted antibiotic therapy plus bracing, represents the mainstay in the management of spondylodiscitis 4.
- Surgery should be an option only for patients with complications of this disease, namely deformity, neural compression, and neurological compromise 4.
- A multidisciplinary approach is advocated, with recommendations for diagnosis and treatment including thorough physical examination, neurological screening, blood tests for infection, and blood cultures 5.
- Ideally, a CT-guided biopsy is performed before treatment is started, and awaiting culture results, all patients should receive broad-spectrum antibiotics 5.