Hyperbaric Oxygen Therapy for Osteomyelitis
HBOT is FDA-approved for refractory osteomyelitis. Learn how it fights chronic bone infections that don't respond to antibiotics and surgery alone.
Hyperbaric Oxygen Therapy for Osteomyelitis
Osteomyelitis is a bone infection that can become nearly impossible to clear once it turns chronic. When antibiotics and surgery aren’t enough, HBOT is an FDA-approved adjunct that helps the body fight infections in poorly oxygenated bone tissue.
What Osteomyelitis Is
Osteomyelitis is a bacterial infection of bone. It can appear suddenly (acute) or persist for months or years despite treatment (chronic or refractory).
Common causes include open fractures, post-surgical infections, infections that spread from nearby soft tissue, and bloodborne bacteria that settle in bone. It’s particularly common in diabetic patients with foot wounds. Diabetic foot osteomyelitis is one of the leading causes of lower limb amputation.
The FDA-approved HBOT indication is specifically for refractory osteomyelitis — cases that don’t respond to antibiotics and surgical debridement alone. Standard acute osteomyelitis that clears with antibiotics doesn’t qualify.
How HBOT Treats Bone Infections
Certain bacteria thrive in low-oxygen environments. Many chronic osteomyelitis cases involve anaerobic organisms that are harder to kill with antibiotics in poorly vascularized tissue.
HBOT floods tissue with dissolved oxygen, making the environment hostile to these bacteria. That alone helps. But the bigger effect is restoring what’s called the oxidative burst — white blood cells need oxygen to destroy bacteria. In bone with impaired blood supply, immune cells often can’t do their job effectively. HBOT restores that capacity.
HBOT also stimulates angiogenesis, the growth of new blood vessels in damaged bone. Better blood supply means better antibiotic delivery and better immune function over time.
It’s always used alongside antibiotics and surgical debridement, not instead of them. Attempting to treat osteomyelitis with HBOT alone isn’t standard care and isn’t what the research supports.
What the Research Shows
Mader and colleagues (1980) published early foundational research showing improved outcomes in chronic osteomyelitis with HBOT used alongside antibiotics and surgery. Their work established the mechanism by which elevated oxygen levels affect bacterial clearance in bone. PMID: 7361392.
Davis and colleagues (1986) studied HBOT as an adjunctive treatment in refractory osteomyelitis cases. PMID: 3517079.
The Undersea and Hyperbaric Medical Society recognizes refractory osteomyelitis as an approved indication. Medicare covers it under National Coverage Determination 20.29.
Who Qualifies
Candidacy requires documentation that standard treatment has failed. Insurance generally won’t cover HBOT for osteomyelitis unless there’s clear evidence that antibiotics and surgical debridement haven’t resolved the infection.
The treating physician — usually an infectious disease specialist, orthopedic surgeon, or wound care physician — works with a hyperbaric medicine physician to confirm candidacy.
Typical protocols run 30 to 40 sessions at 2.0 to 2.4 ATA, five days per week. This is one of the longer HBOT courses. Bone heals slowly, and clearing an infection in poorly vascularized tissue takes time.
See related conditions including diabetic foot wounds and necrotizing soft tissue infections. For cost and coverage details, read the insurance guide and the cost guide. Learn more about how HBOT works.
FAQ
What type of osteomyelitis is HBOT approved for?
HBOT is FDA-approved specifically for refractory osteomyelitis — bone infections that haven’t responded to standard antibiotic therapy and surgical debridement. It’s not typically used for acute osteomyelitis that responds to first-line treatment.
Can HBOT treat osteomyelitis on its own?
No. HBOT is always used as an adjunct — combined with antibiotics and surgical debridement, not as a standalone treatment. Its role is to create conditions that make antibiotics more effective and help the body clear the infection.
How many HBOT sessions does osteomyelitis treatment require?
Typical protocols run 30 to 40 sessions at 2.0 to 2.4 ATA, five days per week. Osteomyelitis is one of the longer HBOT treatment courses because bone heals slowly and infections in poorly vascularized tissue take time to clear.
Does insurance cover HBOT for osteomyelitis?
Insurance may cover HBOT for refractory osteomyelitis, but typically requires documentation that standard antibiotic therapy and surgery have failed. Medicare covers it under National Coverage Determination 20.29. Check with your insurer about prior authorization requirements.
References
Mader, J.T. et al. (1980). A mechanism for the amelioration by hyperbaric oxygen of experimental staphylococcal osteomyelitis in rabbits. PMID: 7361392. https://pubmed.ncbi.nlm.nih.gov/7361392/
Davis, J.C. et al. (1986). Adjuvant hyperbaric oxygen in malignant external otitis. PMID: 3517079. https://pubmed.ncbi.nlm.nih.gov/3517079/
Medical Disclaimer: This page is for informational purposes only. It does not constitute medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider before pursuing any medical treatment.