Osteomyelitis (bone infection)
and Actinomycosis (lumpy jaw)

Hyperbaric Oxygen Therapy Approval Status

Yes Clearance by US Food and Drug Administration (FDA)

Yes Approval by the Undersea and Hyperbaric Medical Society (UHMS) [ 1 ]

About Clearance and Approval


Definition and Causes

Osteomyelitis is a bone infection. Infection may spread to bone from surrounding soft tissue, from elsewhere in the body via the blood, or directly from a bone injury or bone surgery. Osteomyelitis is a serious complication of chronic wounds and necrotizing infections and is a distinctive feature of Wagner Grade 3 diabetic ulcers.

Bone infections may be caused by any number of bacteria or fungi. The most common cause of osteomyelitis is MRSA, or methicillin-resistant Staphylococcus aureus, which has become a particularly troublesome hospital- and healthcare-acquired infection (HAI).

Actinomycosis, or lumpy jaw, a disease common in animals but rare in humans, may be caused by bacteria of the Actinomyces species or by other anaerobic pathogens.

Blocked vessels (ischemia) or poor circulation of oxygenated blood in and around infected bone may lead to inflammation (osteitis), abscess (pus), swelling (edema), pressure, and death (necrosis) of soft and bony tissue.

Evidence Index

FDA cleared, widely reimbursed
Strong body of evidence
Repeatedly favorable results
Early or mixed results
Unfavorable or no evidence
Strong evidence against HBOT

Treatment with Hyperbaric Oxygen Therapy

Hyperbaric oxygen therapy (HBOT) is an effective adjunct to antibiotics and surgery, the traditional treatments for osteomyelitis. When the bacteria involved are anaerobic, meaning they thrive in low-oxygen environments, hyperbaric oxygen kills them and stops them from replicating, spreading, and releasing damaging toxins. HBOT may also improve circulation, boost the effect of antibiotics, deliver infection-fighting blood components to the infection site, and accelerate bone growth and healing.

1 ] Note: The UHMS approval for treatment of osteomyelitis with hyperbaric oxygen therapy applies specifically to refractory osteomyelitis. Refractory means “resistant to treatment”. Clinicians may utilize other treatments, such as antibiotics, for a period of time before assessing an infection as refractory. Hyperbaric oxygen is administered as an adjunct to antibiotics and other therapies. A qualified physician should make the recommendation to treat a bone infection with HBOT.

UHMS guidelines recommend daily treatments of 90-120 minutes at 2.0-3.0 atmospheres of absolute pressure (ATA), starting soon after surgical debridement and continuing 4 to 6 weeks.

Read the page Osteomyelitis (Refractory) in the Undersea and Hyperbaric Medical Society resource library to learn more about persistent or recurring bone infections, the rationale for hyperbaric oxygen therapy, and treatment protocols, key clinical evidence, and success factors.

HyperbaricLink Commentary

Hyperbaric oxygen can be a potent bactericide and also treats the hypoxia at the root of osteomyelitis and surrounding soft tissue necrosis. Osteomyelitis, like necrotizing infections, involves some rather frightening germs. As antibiotics and other traditional weapons against these worrisome microscopic invaders begin to weaken, hyperbaric oxygen therapy provides a vital backstop.

Patient Resources

HyperbaricLink recommends the following websites for anyone seeking authoritative information, patient advocacy, and community support for osteomyelitis.

American Academy of Orthopaedic Surgeons (AAOS)

AAOS is a world-leading provider of musculoskeletal training and education for orthopaedic surgeons. The academy's orthopaedic connection website offers thorough and trustworthy patient information on bone disease, injury, treatment, and rehabilitation, with separate pages on Infections and Bone, Joint, and Muscle Infections in Children.

Partnering to Heal
US Department of Health and Human Services (HHS)

HHS.gov offers healthcare professionals and patients and families an excellent interactive video program about preventing healthcare-associated infections (HAIs).

Clinical Resources

Start with the following resources to explore current research activities and the peer-reviewed medical literature on hyperbaric oxygen therapy for osteomyelitis.

 Use the search buttons below to go directly to research on hyperbaric oxygen therapy.

US National Institutes of Health

ClinicalTrials.gov keeps the official list of human clinical trials currently enrolling, in progress, and recently completed. One may reasonably question the size and legitimacy of any study not listed here.

Search ClinicalTrials.gov

Google Scholar

A specialized Google search engine, Google Scholar indexes scholarly articles, patents, and legal opinions and journals. Google Scholar may produce many search results, but entries provide easy access to full-text journal articles.

Search Google Scholar

Infectious Diseases Society of America (IDSA)

The IDSA provides information, education, and practice guidelines for physicians, scientists, and other healthcare professionals who specialize in infectious diseases.

MRSA Research Center
University of Chicago Medical Center

The MRSA Research Center is a leader in clinical and laboratory research and the go-to information resource for infection control professionals and people affected by methicillin-resistant Staphylococcus aureus.

US National Library of Medicine, National Institutes of Health

PubMed keeps the official list of scientific papers published in reputable peer-reviewed medical journals. One may reasonably question the importance and legitimacy of any study not listed here.

Search PubMed.gov

Partnering to Heal
US Department of Health and Human Services (HHS)

HHS.gov offers healthcare professionals and patients and families an excellent interactive video program about preventing healthcare-associated infections (HAI's).

News About Osteomyelitis and Hyperbaric Oxygen Therapy

One Last Post Re: Success with Hyperbaric Oxygen Therapy for Necrotizing Infections

Tuesday, 7/17

Before we take a break from this topic, here's one more quick but inspiring story about success with hyperbaric oxygen therapy for deadly soft tissue infections, or flesh-eating disease, sometimes including gas gangrene or bone read more...

HBOT for Necrotizing Fasciitis: South Carolina Mother of Twins Going Home with All Her Limbs

Monday, 7/16

Lana Kuykendall, this year's "other" high-profile victim of necrotizing fasciitis, or flesh-eating disease, underwent extensive hyperbaric oxygen therapy as part of her remarkable recovery at Greenville Memorial Hospital in Greenv read more...

Necrotizing Fasciitis Postcript: Aimee Copeland in Rehab, Set to Return Home Next Month

Thursday, 7/12

The young woman we wrote about in May has won her life-or-death battle against necrotizing fasciitis or flesh-eating disease. Hyperbaric oxygen therapy played some role—we don't know the details—in Aimee Copeland's recovery from read more...

More news from O2.0 – the HyperbaricLink blog

Complete osteomyelitis news archive from O2.0 — the HyperbaricLink blog

Further Reading

HyperbaricLink suggests The Doctors' Plague: Germs, Childbed Fever, and the Strange Story of Ignac Semmelweis, by Sherwin B. Nuland, (W. W. Norton & Company, 2003).

The Doctor's Plague cover

Related Terms

  • Abscess
  • Actinomyces
  • Actinomycosis
  • Antibiotic
  • Bacteria
  • Bony necrosis
  • Chronic wounds
  • Compartment syndrome
  • Diabetic ulcers
  • Drug-resistant staph
  • Edema
  • Healthcare-acquired infection (HAI)
  • Hospital-acquired infection (HAI)
  • Hypoxia
  • Ischemia
  • Lumpy jaw
  • Methicillin
  • MRSA
  • Mycobacteria
  • Necrosis
  • Necrotizing infections
  • Nosocomial infection
  • Osteitis
  • Osteogenesis
  • Pycogenic bacteria
  • Soft tissue infections
  • Staphylococcus aureus
  • Wagner grade scale


Undersea and Hyperbaric Medical Society, Indications, Osteomyelitis (Refractory). Retrieved 02 May 2015.
Bone Infections, MedLine Plus, US National Library of Medicine. Retrieved 02 May 2015.
Page Data
Updated: 27 Jul 2015 03:07 PM
Created: 13 Jun 2009 12:00 AM
By: About the authors »