From the Guidelines
The recommended duration of antibiotic treatment for bacterial myositis is 2 to 3 weeks, as stated in the guidelines by the Infectious Diseases Society of America 1. The treatment duration may vary depending on the severity of the infection and the clinical response of the patient.
- For mild to moderate cases, a 2-week course of antibiotics is often sufficient.
- Severe infections may require 3 weeks of therapy. Some common antibiotics used for the treatment of bacterial myositis include:
- Clindamycin (600-900mg IV every 8 hours)
- Cefazolin (1-2g IV every 8 hours)
- Vancomycin (15-20mg/kg IV every 12 hours) for MRSA concerns Oral step-down therapy can be initiated once clinical improvement occurs, with medications like:
- Clindamycin (300-450mg every 6-8 hours)
- Cephalexin (500mg every 6 hours)
- Trimethoprim-sulfamethoxazole (1-2 DS tablets twice daily) Treatment should continue until resolution of symptoms, including pain, swelling, and erythema, normalization of inflammatory markers (CRP, ESR), and absence of fever for at least 48 hours. Longer durations may be necessary for immunocompromised patients, those with abscess formation, or when deep tissue involvement is present, as muscle tissue infections can be difficult to fully penetrate with antibiotics due to the dense tissue structure and potential for abscess formation 1.
From the Research
Treatment of Myositis
The treatment of myositis typically involves the use of glucocorticoids, immunosuppressive agents, and biologic agents.
- Glucocorticoids are considered the mainstay of treatment for myositis 2, 3, 4.
- Immunossuppressive agents such as methotrexate and azathioprine are often used in combination with glucocorticoids to control disease activity and reduce the risk of side effects 2, 4.
- Biologic agents like rituximab have shown promise in treating myositis, particularly in patients with certain myositis-specific autoantibodies 2, 4.
Antibiotic Duration
There is limited information available on the specific duration of antibiotic treatment for myositis.
- However, it is mentioned that intensive surgical and medical therapy, including the administration of intravenous fluids and antimicrobial therapy, is essential in the management of muscle infections 5.
- The choice and duration of antibiotic treatment would depend on the underlying cause of the myositis, such as bacterial infections, and the severity of the disease.
Management of Myositis
The management of myositis involves a multidisciplinary approach, including pharmacological treatment, individualized and supervised exercise, and subgrouping of patients into clinical and serological subtypes 2, 6.