Mandibular Osteomyelitis, Acute

Surgical intervention often needed with sampling for cytology, histology, microscopy and culture
- For suspected actinomycosis contact micro lab
Consult Micro/ID
Prolonged duration of treatment: up to 6 weeks. This can be extended if implant, prothesis or incomplete debridement e.g up to 6 months
Recommended antibiotic therapy listed below is empiric. Treatment should always be tailored to culture and sensitivity
- If candida spp isolated from operative specimen discuss with Micro/ID

IV antibiotics are only indicated if patient is nil-by-mouth or not absorbing.

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amoxicillin 500mg po tds (iv if NBM)

For severe cases: ADD metronidazole 400mg po tds (or 500mg iv tds if NBM) (metronidazole is for a maximum of 10 days)

Mild/moderate disease AND penicillin allergy (non-severe or severe) or MRSA positive

doxycycline 100mg po bd

Severe disease AND penicillin allergy (non-severe or severe) or MRSA positive:

co-trimoxazole 960mg bd po (or iv if NBM)

Preferred