Ceftazidime as single-agent therapy for gram-negative aerobic bacillary osteomyelitis

Abstract

The cases of 28 patients who received ceftazidime as single-agent therapy in prospective clinical trials for biopsy culture-proven osteomyelitis were reviewed. These cases all involved infection caused by gram-negative aerobic bacilli, the most frequent agent (83% of patients) being Pseudomonas aeruginosa. Posttreatment follow-up for patients with acute osteomyelitis was continued for at least 6 months, while follow-up for at least 12 months was done for patients with chronic osteomyelitis. A regimen of 2 g of ceftazidime intravenously every 12 h was used for most patients. The overall cure rates were 77% (acute disease) and 60% (chronic disease). Development of resistance to ceftazidime was not problematic, and the drug was well tolerated. Ceftazidime is effective for serious gram-negative bacillary osteomyelitis, including that due to P. aeruginosa. The twice-daily regimen did not cause major organ toxicity, eliminating the need for concentration monitoring and making it feasible to use the drug for home parenteral therapy.

Antibiotic treatment of osteomyelitis: what have we learned from 30 years of clinical trials?

“…Most of the trials failed to detect statistically significant differences between the two groups, thus providing little understanding about the relative effectiveness of various regimens for treating osteomyelitis. Another limitation of the available literature is that trials involving 'bone and joint infections' include a heterogeneous spectrum of diseases, with different 61 Cefotaxime iv GPC 2 NA 23/24 (96) Mader 62 Ceftizoxime iv GPC and GNR 6 1-12 13/14 4 Gomis 63 Cefotaxime iv E. coli 4 6 40/50 (80) Dutoy 64 Ceftazidime iv P. aeruginosa 4 6 7/7 a 11/14 c Eron 65 Ceftazidime iv P. aeruginosa 6 NA 4/8 1 leukopenia Bach 66 Ceftazidime iv P. aeruginosa 4 6 a 9/11 a 12 c 7/15 c De Bastiani 67 prognoses. For example, the cure rate with antibiotics alone of pediatric hematogenous osteomyelitis is much higher than that of a prosthetic joint infection.…”

Treatment of bone and joint infections caused by Gram-negative bacilli with a cefepime–fluoroquinolone combination

“…Numerous therapeutic approaches to the treatment of bone and joint infections caused by Gram‐negative bacilli (GNB) have been described [1–6]. Several reports [7–10] have demonstrated that fluoroquinolones inhibit the adherence of GNB to implanted devices.…”

“…Only a limited number of experimental models [17–19] have been described, although these have demonstrated high bone concentrations of fluoroquinolones above the MICs for most GNB [1–3,6–8,13,17–19]. Further, randomised controlled clinical trials are hampered by the fact that only large institutions have sufficient patients for such studies, and successful treatment requires a follow‐up period of 1–2 years [1–6,11,16]. Several trials with ceftazidime/fluoroquinolone [1,2,4], a fluoroquinolone alone [3,5] or imipenem‐cilastatin [6] have been reported, with degrees of success.…”

“…Further, randomised controlled clinical trials are hampered by the fact that only large institutions have sufficient patients for such studies, and successful treatment requires a follow‐up period of 1–2 years [1–6,11,16]. Several trials with ceftazidime/fluoroquinolone [1,2,4], a fluoroquinolone alone [3,5] or imipenem‐cilastatin [6] have been reported, with degrees of success. In the present study, the C min of cefepime compared favourably with published reports [19], and was generally greater than the MICs for most GNB.…”

Ofloxacin versus parenteral therapy for chronic osteomyelitis

“…In our center, aminoglycosides such as gentamicin are rarely used to treat chronic osteomyelitis. The beta-lactam antimicrobial agents, especially the cephalosporins, have been proven to be effective and safe as monotherapy for chronic osteomyelitis caused by susceptible organisms (1,4).…”