Osteomyelitis Quiz: Ace Your Exams

A 60-year-old man presents to the clinic with a 6-week history of progressive painless swelling of his lower jaw. This past week, he started having drainage from the overlying skin which prompted him to get evaluated. He had extensive dental work 10 weeks ago. Past medical history is significant for poorly controlled type 2 diabetes mellitus for which he takes metformin and insulin. He has no known drug allergies. Temperature is 37.3°C (99.1°F), heart rate is 80/min, blood pressure is 130/85 mm Hg, respiratory rate is 17/min, and oxygen saturation is 97% on room air. Physical examination reveals a swollen indurated area of the mandible at the angle of the lower jaw on the left with yellow granules in the discharge from two distinct sinus tracts open to the skin. Laboratory tests show a white blood cell count of 17,500/µL and C-reactive protein of 45 mg/L. Radiographs of the jaw show left jaw bone destruction with periosteal reaction. Gram stain of the fluid shows filaments as seen below with culture pending. Which of the following is the best next step in management?
  ^{Taken from the Public Health Image Library (PHIL)}