eMedicine Specialties > Emergency Medicine > Infectious Diseases

Osteomyelitis: Treatment & Medication

Author: Randall W King, MD, Assistant Clinical Professor of Emergency Medicine, Medical College of Ohio; Program Director, Associate Chair, Department of Emergency Medicine, St Vincent Mercy Medical Center
Coauthor(s): David Johnson, MD, Assistant Clinical Professor, Department of Surgery, Medical University of Ohio; Associate Chair, Department of Emergency Services, Director, Lucas County Emergency, St Vincent's Mercy Medical Center
Contributor Information and Disclosures

Updated: Nov 4, 2008

Treatment

Emergency Department Care

Osteomyelitis rarely requires emergent stabilization or resuscitation. The primary challenge for ED physicians is considering the appropriate diagnosis in the face of subtle signs or symptoms.

Treatment for osteomyelitis involves the following:

  • Initiation of intravenous antibiotics that penetrate bone and joint cavities
  • Referral of the patient to an orthopedist or general surgeon
  • Possible medical infectious disease consultation

Select the appropriate antibiotics using direct culture results in samples from the infected site, whenever possible. Empiric therapy is often initiated on the basis of the patient's age and the clinical presentation. Further surgical management may involve removal of the nidus of infection, implantation of antibiotic beads or pumps, hyperbaric oxygen therapy, or other modalities.

Diagnosis requires 2 of the 4 following criteria:

  • Purulent material on aspiration of affected bone
  • Positive findings of bone tissue or blood culture
  • Localized classic physical findings of bony tenderness, with overlying soft-tissue erythema or edema
  • Positive radiological imaging study

Consultations

Order an orthopedics, general surgery, or infectious disease consultation, as needed.

Medication

The primary treatment for osteomyelitis is parenteral antibiotics that penetrate bone and joint cavities. Treatment is required for at least 4-6 weeks. After intravenous antibiotics are initiated on an inpatient basis, therapy may be continued with intravenous or oral antibiotics, depending on the type and location of the infection, on an outpatient basis.

The following are recommendations for the initiation of empiric antibiotic treatment based on the age of the patient and mechanism of infection:

  • With hematogenous osteomyelitis (newborn to adult), the infectious agents include S aureus, Enterobacteriaceae organisms, group A and B Streptococcus species, and H influenzae. Primary treatment is a combination of penicillinase-resistant synthetic penicillin and a third-generation cephalosporin. Alternate therapy is vancomycin or clindamycin and a third-generation cephalosporin, particularly if MRSA is considered likely. Linezolid is also used in these circumstances. In addition to these above-mentioned antibacterials, ciprofloxacin and rifampin may be an appropriate combination therapy for adult patients. If there is evidence of infection with gram-negative bacilli, include a third-generation cephalosporin.
  • In patients with sickle cell anemia and osteomyelitis, the primary bacterial causes are S aureus and Salmonellae species. Thus, the primary choice for treatment is a fluoroquinolone antibiotic (not in children). A third-generation cephalosporin (eg, ceftriaxone) is an alternative choice.
  • When a nail puncture occurs through an athletic shoe, the infecting agents may include S aureus and Pseudomonas aeruginosa. The primary antibiotics in this scenario include ceftazidime or cefepime. Ciprofloxacin is an alternative treatment.
  • For patients with osteomyelitis due to trauma, the infecting agents include S aureus, coliform bacilli, and Pseudomonas aeruginosa. Primary antibiotics are nafcillin and ciprofloxacin. Alternatives include vancomycin and a third-generation cephalosporin with antipseudomonal activity.

Antibiotics

Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting.


Nafcillin (Nafcil, Unipen)

Initial therapy for suspected penicillin G–resistant streptococcal or staphylococcal infections. Use parenteral therapy initially in severe infections. Change to oral therapy as condition warrants. Because of thrombophlebitis, particularly in elderly patients, administer parenterally for only the short term (1-2 d). Change to PO route as clinically indicated. Note: Administer in combination with a third-generation cephalosporin to treat osteomyelitis. Do not admix with aminoglycosides for IV administration.

Adult

1-2 g IV/IM q4h; reduce dose 35-50% in severe renal or hepatic impairment; change to PO as clinically indicated

Pediatric

100-200 mg/kg/d IV/IM divided q6h; maximum 12 g/d; change to PO as clinically indicated

Associated with warfarin resistance when administered concurrently; effects may decrease with bacteriostatic action of tetracycline derivatives

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

To optimize therapy, determine causative organisms and susceptibility; treatment should last more than 10 d to eliminate infection and prevent sequelae (eg, endocarditis, rheumatic fever); perform cultures after treatment to confirm that infection is eradicated


Ceftriaxone (Rocephin)

Third-generation cephalosporin with broad-spectrum gram-negative activity; lower efficacy against gram-positive organisms; higher efficacy against resistant organisms; arrests bacterial growth by binding to one or more penicillin-binding proteins. Note: Administer with a penicillinase-resistant synthetic penicillin, when treating osteomyelitis.

Adult

2 g IV qd

Pediatric

75 mg/kg/d IV qd

Probenecid may increase levels; coadministration with ethacrynic acid, furosemide, and aminoglycosides may increase nephrotoxicity

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Adjust dose in renal impairment; caution in women who are breastfeeding and in patients with an allergy to penicillin


Cefazolin (Ancef)

First-generation semisynthetic cephalosporin that arrests bacterial cell wall synthesis, inhibiting bacterial growth; primarily active against skin flora, including S aureus; typically used alone for skin and skin-structure coverage.

Adult

2 g IV/IM q8h; not to exceed 12 g/d

Pediatric

20 mg/kg/d IV/IM divided q8h depending on severity of infection; not to exceed 6 g/d

Probenecid prolongs effect; coadministration with aminoglycosides may increase renal toxicity; may yield false-positive results for glucose at urine-dip testing

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Adjust dose in renal impairment; superinfections, promotion of nonsusceptible organisms, and pancytopenia may occur with prolonged use or repeated therapy; complications are usually reversible


Ciprofloxacin (Cipro)

Fluoroquinolone with activity against pseudomonads, streptococci, MRSA, Staphylococcus epidermidis, and most gram-negative organisms, but no activity against anaerobes. Inhibits bacterial DNA synthesis and, consequently, growth. Continue treatment for at least 2 d (typical treatment, 7-14 d) after signs and symptoms disappear.

Adult

200-400 mg IV q12h

Pediatric

<18 years: Not recommended
>18 years: Administer as in adults

Antacids, iron salts, and zinc salts may reduce serum levels; if used, administer antacids no sooner than 2-4 h before or after administration; cimetidine may interfere with metabolism of fluoroquinolones; ciprofloxacin reduces therapeutic effects of phenytoin; probenecid may increase ciprofloxacin serum concentrations; may increase toxicity of theophylline, caffeine, cyclosporine, and digoxin (monitor digoxin levels); may increase effects of anticoagulants (monitor PT)

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

In prolonged therapy, periodically evaluate organ system (eg, renal, hepatic, hematopoietic) functions; adjust dose in renal function impairment; superinfections may occur with prolonged or repeated antibiotic therapy


Ceftazidime (Fortaz, Ceptaz)

Third-generation cephalosporin with broad-spectrum gram-negative activity; lower efficacy against gram-positive organisms; higher efficacy against resistant organisms; arrests bacterial growth by binding to one or more penicillin-binding proteins.

Adult

2 g IV q8h

Pediatric

150 mg/kg/d IV divided q8h; not to exceed 6 g/d

Nephrotoxicity may increase with aminoglycosides, furosemide, and ethacrynic acid use; probenecid may increase ceftazidime levels

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Adjust dose in renal impairment


Clindamycin (Cleocin)

Lincosamide for the treatment of serious skin and soft-tissue staphylococcal infections; also effective against aerobic and anaerobic streptococci (except enterococci); inhibits bacterial growth, possibly by blocking dissociation of peptidyl t-RNA from ribosomes, arresting RNA-dependent protein synthesis.

Adult

600-1200 mg/d IV/IM divided q6-8h, depending on the degree of infection

Pediatric

20-40 mg/kg/d IV/IM divided tid/qid
Severe infections: May increase dose to 16-20 mg/kg/d IV/IM divided tid/qid

Increases duration of neuromuscular blockade induced by tubocurarine and pancuronium; erythromycin may antagonize effects; antidiarrheals may delay absorption

Documented hypersensitivity; regional enteritis, ulcerative colitis; hepatic impairment; antibiotic-associated colitis

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Adjust dose in severe hepatic dysfunction; no adjustment necessary in renal insufficiency; associated with severe and possibly fatal colitis


Vancomycin (Vancocin)

Potent antibiotic directed against gram-positive organisms and active against Enterococcus species. Useful in the treatment of septicemia and skin structure infections. Indicated for patients who can not receive or have failed to respond to penicillins and cephalosporins or have infections with resistant staphylococci. For abdominal penetrating injuries, it is combined with an agent active against enteric flora and/or anaerobes.
To avoid toxicity, current recommendation is to assay vancomycin trough levels after third dose drawn 0.5 h prior to next dosing. Use creatinine clearance to adjust dose in patients with renal impairment.
Used in conjunction with gentamicin for prophylaxis in penicillin-allergic patients undergoing gastrointestinal or genitourinary procedures.

Adult

500 mg to 2 g/d IV divided tid/qid 7-10 d

Pediatric

40 mg/kg/d IV divided tid/qid 7-10 d

Erythema, histaminelike flushing, and anaphylactic reactions may occur when administered with anesthetic agents; taken concurrently with aminoglycosides, risk of nephrotoxicity may increase above that with aminoglycoside monotherapy; effects in neuromuscular blockade may be enhanced when coadministered with nondepolarizing muscle relaxants

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Caution in renal failure, neutropenia; red man syndrome is caused by too rapid IV infusion (dose given over a few min) but rarely happens when dose given IV over 2 h administration or as PO or IP administration; red man syndrome is not an allergic reaction


Linezolid (Zyvox)

Prevents formation of functional 70S initiation complex, which is essential for bacterial translation process. Bacteriostatic against staphylococci.

Adult

400-600 mg PO/IV q12h

Pediatric

Preterm neonate <7 days: 10 mg/kg PO/IV q12h
Term neonates to 12 years: 10 mg/kg PO/IV q8h
>12 years: Administer as in adults

May cause hypertension when used concomitantly with adrenergic agents including pseudoephedrine, sympathomimetic agents, vasopressor or dopaminergic agents (reduce dose of dopamine or epinephrine if concurrent use required); serotonin syndrome may occur if used concomitantly with serotonergic agents including tricyclic antidepressants, meperidine, dextromethorphan, trazodone, venlafaxine, and selective serotonin reuptake; may cause myelosuppression or pseudomembranous colitis inhibitors

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Has mild MAO inhibitor properties and has potential to have same interactions as other MAO inhibitors; caution in uncontrolled hypertension, pheochromocytoma, carcinoid syndrome, or untreated hyperthyroidism, and patients who are at increased risk for bleeding, have preexisting thrombocytopenia, receive concomitant medications that may decrease platelet count or function, or who may require >2 wk of therapy (monitor platelet counts); unnecessary use may lead to development of resistance to drug; may cause peripheral or optic neuropathy

More on Osteomyelitis

Overview: Osteomyelitis
Differential Diagnoses & Workup: Osteomyelitis
Treatment & Medication: Osteomyelitis
Follow-up: Osteomyelitis
Multimedia: Osteomyelitis
References

References

  1. Crary SE, Buchanan GR, Drake CE, Journeycake JM. Venous thrombosis and thromboembolism in children with osteomyelitis. J Pediatr. Oct 2006;149(4):537-41. [Medline].

  2. Germain ML, Krenzer KA, Hasley BP, Varman M. 11-month-old child refuses to sit up. Pediatr Ann. May 2008;37(5):290-3. [Medline].

  3. Kiang KM, Ogunmodede F, Juni BA, Boxrud DJ, Glennen A, Bartkus JM. Outbreak of osteomyelitis/septic arthritis caused by Kingella kingae among child care center attendees. Pediatrics. Aug 2005;116(2):e206-13. [Medline].

  4. Aloui N, Nessib N, Jalel C. [Acute osteomyelitis in children: early MRI diagnosis]. J Radiol. Apr 2004;85(4 Pt 1):403-8. [Medline].

  5. Asmar BI. Osteomyelitis in the neonate. Infect Dis Clin North Am. Mar 1992;6(1):117-32. [Medline].

  6. Bamberger DM. Diagnosis and treatment of osteomyelitis. Compr Ther. Summer 2000;26(2):89-95. [Medline].

  7. Bocchini CE, Hulten KG, Mason EO. Panton-Valentine leukocidin genes are associated with enhanced inflammatory response and local disease in acute hematogenous Staphylococcus aureus osteomyelitis in children. Pediatrics. Feb 2006;117(2):433-40. [Medline].

  8. Cheatle MD. The effect of chronic orthopedic infection on quality of life. Orthop Clin North Am. Jul 1991;22(3):539-47. [Medline].

  9. Chisholm CD, Schlesser JF. Plantar puncture wounds: controversies and treatment recommendations. Ann Emerg Med. Dec 1989;18(12):1352-7. [Medline].

  10. Dinh MT, Abad CL, Safdar N. Diagnostic accuracy of the physical examination and imaging tests for osteomyelitis underlying diabetic foot ulcers: meta-analysis. Clin Infect Dis. Aug 15 2008;47(4):519-27. [Medline].

  11. Fowler VG, Justice A, Moore C. Risk factors for hematogenous complications of intravascular catheter-associated Staphylococcus aureus bacteremia. Clin Infect Dis. Mar 1 2005;40(5):695-703. [Medline].

  12. Gelfand MS, Cleveland KO. Vancomycin therapy and the progression of methicillin-resistant Staphylococcus aureus vertebral osteomyelitis. South Med J. Jun 2004;97(6):593-7. [Medline].

  13. Goergens ED, McEvoy A, Watson M, Barrett IR. Acute osteomyelitis and septic arthritis in children. J Paediatr Child Health. Jan-Feb 2005;41(1-2):59-62. [Medline].

  14. Gosselin RA, Roberts I, Gillespie WJ. Antibiotics for preventing infection in open limb fractures. Cochrane Database Syst Rev. 2004;CD003764. [Medline].

  15. Harwood PJ, Talbot C, Dimoutsos M. Early experience with linezolid for infections in orthopaedics. Injury. Apr 16 2006;[Medline].

  16. Hollmig ST, Copley LA, Browne RH, Grande LM, Wilson PL. Deep venous thrombosis associated with osteomyelitis in children. J Bone Joint Surg Am. Jul 2007;89(7):1517-23. [Medline].

  17. Hsu LY, Koh TH, Tan TY. Emergence of community-associated methicillin-resistant Staphylococcus aureus in Singapore: a further six cases. Singapore Med J. Jan 2006;47(1):20-6. [Medline].

  18. Kabak S, Tuncel M, Halici M. Role of trauma on acute haematogenic osteomyelitis aetiology. Eur J Emerg Med. Sep 1999;6(3):219-22. [Medline].

  19. Kaiser S, Jorulf H, Hirsch G. Clinical value of imaging techniques in childhood osteomyelitis. Acta Radiol. Sep 1998;39(5):523-31. [Medline].

  20. Karamanis EM, Matthaiou DK, Moraitis LI, Falagas ME. Fluoroquinolones versus beta-lactam based regimens for the treatment of osteomyelitis: a meta-analysis of randomized controlled trials. Spine. May 1 2008;33(10):E297-304. [Medline].

  21. Kindwall EP. Uses of hyperbaric oxygen therapy in the 1990s. Cleve Clin J Med. Sep-Oct 1992;59(5):517-28. [Medline].

  22. Mandracchia VJ, Sanders SM, Jaeger AJ. Management of osteomyelitis. Clin Podiatr Med Surg. Jul 2004;21(3):335-51. [Medline].

  23. Martinez-Aguilar G, Avalos-Mishaan A, Hulten K. Community-acquired, methicillin-resistant and methicillin-susceptible Staphylococcus aureus musculoskeletal infections in children. Pediatr Infect Dis J. Aug 2004;23(8):701-6. [Medline].

  24. Martinez-Aguilar G, Hammerman WA, Mason EO. Clindamycin treatment of invasive infections caused by community-acquired, methicillin-resistant and methicillin-susceptible Staphylococcus aureus in children. Pediatr Infect Dis J. Jul 2003;22(7):593-8. [Medline].

  25. Moumile K, Merckx J, Glorion C, Pouliquen JC, Berche P, Ferroni A. Bacterial aetiology of acute osteoarticular infections in children. Acta Paediatr. Apr 2005;94(4):419-22. [Medline].

  26. Nicolau DP, Nie L, Tessier PR. Prophylaxis of acute osteomyelitis with absorbable ofloxacin-impregnated beads. Antimicrob Agents Chemother. Apr 1998;42(4):840-2. [Medline].

  27. Perron AD, Brady WJ, Miller MD. Orthopedic pitfalls in the ED: osteomyelitis. Am J Emerg Med. Jan 2003;21(1):61-7. [Medline].

  28. Rao N, Ziran BH, Hall RA. Successful treatment of chronic bone and joint infections with oral linezolid. Clin Orthop Relat Res. Oct 2004;67-71. [Medline].

  29. Rasmont Q, Yombi JC, Van der Linden D, Docquier PL. Osteoarticular infections in Belgian children: a survey of clinical, biological, radiological and microbiological data. Acta Orthop Belg. Jun 2008;74(3):374-85. [Medline].

  30. Restrepo CS, Lemos DF, Gordillo H. Imaging findings in musculoskeletal complications of AIDS. Radiographics. Jul-Aug 2004;24(4):1029-49. [Medline].

  31. Roberts DE. Femoral osteomyelitis after tooth extraction. Am J Orthop. Sep 1998;27(9):624-6. [Medline].

  32. Saavedra-Lozano J, Mejías A, Ahmad N, Peromingo E, Ardura MI, Guillen S, et al. Changing trends in acute osteomyelitis in children: impact of methicillin-resistant Staphylococcus aureus infections. J Pediatr Orthop. Jul-Aug 2008;28(5):569-75. [Medline].

  33. Sadat-Ali M. The status of acute osteomyelitis in sickle cell disease. A 15-year review. Int Surg. Jan-Mar 1998;83(1):84-7. [Medline].

  34. Sammak B, Abd El Bagi M, Al Shahed M. Osteomyelitis: a review of currently used imaging techniques. Eur Radiol. 1999;9(5):894-900. [Medline].

  35. Schauwecker DS. The scintigraphic diagnosis of osteomyelitis. AJR Am J Roentgenol. Jan 1992;158(1):9-18. [Medline].

  36. Segev S, Yaniv I, Haverstock D. Safety of long-term therapy with ciprofloxacin: data analysis of controlled clinical trials and review. Clin Infect Dis. Feb 1999;28(2):299-308. [Medline].

  37. Seligson D, Klemm K. Adult posttraumatic osteomyelitis of the tibial diaphysis of the tibial shaft. Clin Orthop. Mar 1999;(360):30-6. [Medline].

  38. Shedek BK, Nilles EJ. Community-associated methicillin-resistant Staphylococcus aureus pyomyositis complicated by compartment syndrome in an immunocompetent young woman. Am J Emerg Med. Jul 2008;26(6):737.e3-4. [Medline].

  39. Shih HN, Shih LY, Wong YC. Diagnosis and treatment of subacute osteomyelitis. J Trauma. Jan 2005;58(1):83-7. [Medline].

  40. Sonnen GM, Henry NK. Pediatric bone and joint infections. Diagnosis and antimicrobial management. Pediatr Clin North Am. Aug 1996;43(4):933-47. [Medline].

  41. Steer AC, Carapetis JR. Acute hematogenous osteomyelitis in children: recognition and management. Paediatr Drugs. 2004;6(6):333-46. [Medline].

  42. Stengel D, Bauwens K, Sehouli J, Ekkernkamp A, Porzsolt F. Systematic review and meta-analysis of antibiotic therapy for bone and joint infections. Lancet Infect Dis. Oct 2001;1(3):175-88. [Medline].

  43. Trobs R, Moritz R, Buhligen U. Changing pattern of osteomyelitis in infants and children. Pediatr Surg Int. Jul 1999;15(5-6):363-72. [Medline].

  44. Tsukayama DT. Pathophysiology of posttraumatic osteomyelitis. Clin Orthop. Mar 1999;(360):22-9. [Medline].

  45. Vuagnat A, Stern R, Lotthe A. High dose vancomycin for osteomyelitis: continuous vs. intermittent infusion. J Clin Pharm Ther. Aug 2004;29(4):351-7. [Medline].

  46. Waagner DC. Musculoskeletal infections in adolescents. Adolesc Med. Jun 2000;11(2):375-400. [Medline].

  47. Walenkamp GH, Kleijn LL, de Leeuw M. Osteomyelitis treated with gentamicin-PMMA beads: 100 patients followed for 1-12 years. Acta Orthop Scand. Oct 1998;69(5):518-22. [Medline].

  48. Walters HL, Measley R. Two cases of Pseudomonas aeruginosa epidural abscesses and cervical osteomyelitis after dental extractions. Spine. Apr 20 2008;33(9):E293-6. [Medline].

  49. Wang C, Schwaitzberg S, Berliner E, Zarin DA, Lau J. Hyperbaric oxygen for treating wounds: a systematic review of the literature. Arch Surg. Mar 2003;138(3):272-9; discussion 280. [Medline].

  50. Yun HC, Branstetter JG, Murray CK. Osteomyelitis in military personnel wounded in Iraq and Afghanistan. J Trauma. Feb 2008;64(2 Suppl):S163-8; discussion S168. [Medline].

  51. Zalavras CG, Patzakis MJ, Holtom P. Local antibiotic therapy in the treatment of open fractures and osteomyelitis. Clin Orthop Relat Res. Oct 2004;86-93. [Medline].

Further Reading

Keywords

osteomyelitis, bone infection, central osteitis, hematogenous osteomyelitis, direct inoculation osteomyelitis, chronic osteomyelitis, osteomyelitis secondary to peripheral vascular diseasecontiguous inoculation osteomyelitis, vertebral osteomyelitis, spinal-cord compression, spinal osteomyelitis, Staphylococcus aureus, Enterobacter species, Haemophilus influenzae, Streptococcus species, Pseudomonas species, Salmonellae species, diabetes mellitus, sickle cell disease, acquired immune deficiency syndrome, AIDS, IV drug abuse, alcoholism, chronic steroid use, immunosuppression, chronic joint disease, MRSA, methicillin-resistant Staphylococcus aureus, community-associated methicillin-resistant Staphylococcus aureus, Kingella kingae

Contributor Information and Disclosures

Author

Randall W King, MD, Assistant Clinical Professor of Emergency Medicine, Medical College of Ohio; Program Director, Associate Chair, Department of Emergency Medicine, St Vincent Mercy Medical Center
Randall W King, MD is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, National Association of EMS Physicians, Ohio State Medical Association, Society for Academic Emergency Medicine, and Wilderness Medical Society
Disclosure: Challenger corporation None Other

Coauthor(s)

David Johnson, MD, Assistant Clinical Professor, Department of Surgery, Medical University of Ohio; Associate Chair, Department of Emergency Services, Director, Lucas County Emergency, St Vincent's Mercy Medical Center
Disclosure: Nothing to disclose.

Medical Editor

Dana A Stearns, MD, Assistant Director of Undergraduate Education, Department of Emergency Medicine, Massachusetts General Hospital
Dana A Stearns, MD is a member of the following medical societies: American Academy of Emergency Medicine and American College of Emergency Physicians
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Eric L Weiss, MD, DTM&H, Director of Stanford Travel Medicine, Medical Director of Stanford Lifeflight, Assistant Professor, Departments of Emergency Medicine and Infectious Diseases, Stanford University School of Medicine
Eric L Weiss, MD, DTM&H is a member of the following medical societies: American College of Emergency Physicians, American College of Occupational and Environmental Medicine, American Medical Association, American Society of Tropical Medicine and Hygiene, Physicians for Social Responsibility, Southeastern Surgical Congress, Southern Association for Oncology, Southern Clinical Neurological Society, and Wilderness Medical Society
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Jonathan Adler, MD, Attending Physician, Department of Emergency Medicine, Massachusetts General Hospital; Division of Emergency Medicine, Harvard Medical School
Jonathan Adler, MD is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine
Disclosure: eMedicine.com, Inc. Consulting fee Consulting

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.