The patient was started on a 6-week course of intravenous ceftriaxone 2g/d, which she continued to receive at home via a peripherally inserted central catheter. The patient was instructed at discharge (on Day 8) to follow up with her FP, which she did 12 days later. At that visit, her back pain was improved and her ESR and CRP levels were within normal ranges.
When evaluating a patient who presents with low back pain, perform a focused history and be on the lookout for “red flags” that warrant further imaging and testing. Routine imaging is not recommended for patients with nonspecific low back pain, but imaging may be indicated for patients with neurologic deficits or nerve root tension signs.
A patient with low back pain caused by osteomyelitis may present with fever, elevated ESR, and/or motor deficits. Identifying the bacteria underlying the infection will help guide selection of appropriate antibiotics.