ORAL ANTIMICROBIAL THERAPY FOR OSTEOMYELITIS

Recently developed oral antibiotics, notably the fluoroquinolones, have been shown to be effective and safe as antimicrobial therapy for patients with biopsy-confirmed osteomyelitis due to susceptible organisms, provided complete surgical debridement of the bone precedes drug therapy. Historically, the oral penicillins have been effective therapy for chronic osteomyelitis due to susceptible staphylococci, but broader-spectrum therapy is now required because of the increasing number of bone infections due to gram-negative bacteria and to polymicrobial causes. Ciprofloxacin, the most extensively studied fluoroquinolone agent in osteomyelitis, has shown a long-term success rate of 76% and a rate of tolerability of 98% in patients on extended courses (average duration, 74 days). Findings in patients treated with ofloxacin or pefloxacin have been similar, but these drugs have been less extensively studied. In randomized trials, ciprofloxacin and ofloxacin have been shown to be as effective as modern parenteral therapies. Clinical outcomes in patients with diabetes mellitus or peripheral vascular disease have varied from almost uniform success for infections due to Enterobacteriaceae to somewhat frequent emergence of resistance in Pseudomonas 'aeruginosa. In addition, there are renewed concerns about emergence of quinolone resistance in staphylococci.