From the Research
Chronic and acute osteomyelitis differ primarily in their duration, presentation, and treatment approaches, with chronic osteomyelitis requiring a multidisciplinary approach and prolonged treatment due to its complex and persistent nature. The key differences between chronic and acute osteomyelitis include:
- Duration: Acute osteomyelitis develops rapidly, typically within two weeks of infection, while chronic osteomyelitis persists beyond 6-8 weeks.
- Presentation: Acute osteomyelitis presents with sudden onset of fever, severe pain, swelling, warmth, and redness over the affected bone, while chronic osteomyelitis shows less systemic symptoms but more bone destruction on imaging.
- Treatment: Acute osteomyelitis usually involves 4-6 weeks of antibiotics, while chronic osteomyelitis requires prolonged antibiotic therapy (often 3-6 months), surgical debridement of necrotic tissue, and sometimes muscle flaps or bone grafts.
According to the most recent and highest quality study 1, chronic osteomyelitis represents a progressive inflammatory process caused by pathogens, resulting in bone destruction and sequestrum formation, and its management remains challenging, requiring a multidisciplinary approach. The study also highlights the importance of a combined antimicrobial and surgical treatment, including appropriate dead space management and subsequent reconstruction.
In terms of treatment, a combined antimicrobial and surgical treatment should be considered in all cases of chronic osteomyelitis, including appropriate dead space management and subsequent reconstruction. The choice of antibiotic therapy should be based on culture results and susceptibility testing, and may include oral or parenteral antibiotics, such as vancomycin or cefazolin, for a prolonged period of time 2, 3, 4.
It is also important to note that chronic osteomyelitis may lead to complications like pathological fractures and malignant transformation in long-standing cases, and that relapse can occur, even following an apparently successful treatment, which has a major impact on the quality of life of patients and is a substantial financial burden to any healthcare system 1.