Why Bone Infections Are So Difficult to Treat

Osteomyelitis is an infection of bone that can be caused by bacteria reaching the bone through the bloodstream, from a nearby infection, or through direct contamination during surgery or trauma. Chronic osteomyelitis, which persists despite standard antibiotic therapy, is one of the most frustrating conditions in medicine. The infection creates pockets of dead bone called sequestra, which harbor bacteria in a low-oxygen environment where antibiotics cannot reach effective concentrations and immune cells cannot function properly.

This creates a vicious cycle: the infection destroys bone tissue and blood vessels, the resulting poor blood supply prevents antibiotics and immune cells from reaching the bacteria, and the infection persists. Breaking this cycle requires more than antibiotics alone, which is why hyperbaric oxygen therapy is recognized as an important adjunctive treatment for refractory osteomyelitis.

How HBOT Fights Bone Infections

HBOT attacks osteomyelitis through multiple complementary mechanisms. First, it dramatically increases oxygen levels in infected bone tissue. Many bacteria that cause osteomyelitis, particularly anaerobic organisms, cannot survive in high-oxygen environments. The elevated oxygen tension created by HBOT is directly bactericidal to these organisms.

Second, HBOT restores the oxygen-dependent killing ability of white blood cells. Neutrophils require oxygen to generate the reactive oxygen species they use to destroy bacteria. In the hypoxic environment of infected bone, neutrophil killing is severely impaired. HBOT restores this function to normal or enhanced levels.

Third, HBOT enhances the effectiveness of certain antibiotics. Aminoglycosides, fluoroquinolones, and other antibiotic classes work more effectively at higher oxygen tensions. HBOT allows these antibiotics to penetrate deeper into infected bone and kill bacteria more efficiently. Over the treatment course, HBOT drives new blood vessel growth into the infected area and mobilizes stem cells that contribute to bone regeneration.

Clinical Evidence

Studies on HBOT for chronic refractory osteomyelitis have shown improved cure rates when HBOT is added to surgical debridement and antibiotic therapy. Research has demonstrated infection resolution rates of 80 to 85 percent in patients treated with the combination of surgery, antibiotics, and HBOT. HBOT is particularly valuable for osteomyelitis in patients with diabetes or peripheral vascular disease. Explore the evidence on our HBOT research library.

Treatment Protocol

HBOT for osteomyelitis is used as an adjunct to surgical debridement and targeted antibiotic therapy. The typical protocol involves 20 to 40 sessions at 2.0 to 2.5 ATA in a medical-grade chamber. Treatment is divided into a pre-surgical phase and a post-surgical phase. Read about what to expect at your first session.

Treatment at National Hyperbaric

Osteomyelitis is an FDA-approved indication for HBOT covered by most insurance including Medicare. Our physicians, Dr. Allan Spiegel and Dr. Montana, coordinate with your orthopedic surgeon and infectious disease specialist. Learn about choosing the right HBOT provider. Contact us for a free consultation. Visit our cost and insurance page and explore all conditions we treat. We offer travel for treatment support and have answers on our FAQ.