Acute osteomyelitis comprised 78 (29.3%) of the 266 major skeletal complications seen in 207 patients with sickle cell disease in a five and a half year period. Forty eight (61.5%) of the 78 patients were under the age of 15 years, and the mean age at onset was 12 years (range 9 months to 50 years). Osteomyelitis was often multifocal (in 42% of the cases) and associated with some life threatening disorders. Salmonella accounted for 50% of the 36 organisms isolated from 32 patients with bacteriologically confirmed diagnosis. The 'best guess' antibiotic was a combination of chloramphenicol and cloxacillin. Medical treatment alone proved adequate in most cases. No deaths resulted, but 55% of the patients developed serious complications due partly to the severity of the disease and also to infection involving the epiphyses and joints.