Vertebral Osteomyelitis — SCE Infectious Diseases MCQ

Correct answer: C — 6 weeks of targeted antibiotic therapy

This is bacterial native vertebral osteomyelitis/discitis: subacute back pain, fever, raised inflammatory markers, MRI vertebral endplate/body destruction with disc-space narrowing and paravertebral collection, and biopsy culture growing MSSA. Once microbiology is known, treatment should be culture-directed anti-staphylococcal therapy, with infection specialist input and source control/drainage if indicated. The recommended duration for most bacterial native vertebral osteomyelitis/discitis is a total of 6 weeks of targeted antibiotics. The IV-to-oral switch is not fixed at a mandatory 2-week IV then 4-week oral schedule; it depends on clinical response, organism, susceptibility, bioavailability and specialist advice. Twelve weeks is not standard for uncomplicated MSSA native vertebral osteomyelitis, 6 months is for spinal tuberculosis, and 4 weeks alone is inadequate.

Reference: University Hospitals Birmingham NHS Foundation Trust. Adult Antimicrobial Prescribing Guidelines, version reviewed June 2026, section: Vertebral Osteomyelitis/Discitis/Spinal Epidural Abscess — recommends a total duration of 6 weeks of antibiotics for most bacterial native vertebral osteomyelitis or discitis. https://www.uhb.nhs.uk/media/513l1wph/antimicrobialprescribingguidelines.pdf