Ofloxacin versus parenteral therapy for chronic osteomyelitis

Abstract

We conducted a randomized comparison of oral ofloxacin (400 mg twice a day) and parenteral agents (cefazolin, 1.0 g intravenously every 8 h, or ceftazidime, 2.0 g intravenously every 12 h) in biopsy-confirmed, nonprosthesis osteomyelitis. A total of 19 subjects received ofloxacin for an average of 8 weeks, and 14 received parenteral antibiotics for an average of 4 weeks; both therapies were well tolerated. Infections were due to Staphylococcus aureus (40%), Enterococcus spp. (3%), Pseudomonas aeruginosa (15%), and other gram-negative organisms (42%). At the completion of therapy, one P. aeruginosa infection in the ofloxacin group persisted and the organism acquired resistance, accompanied by a resistant Acinetobacter superinfection. In the parenteral group, one S. aureus infection persisted, and there was a resolved superinfection due to S. aureus as well. Eighteen-month follow-up data have been obtained. Among those treated with ofloxacin, four subjects whose initial response to therapy was successful suffered relapses of infection, three due to S. aureus and one due to P. aeruginosa, while in the parenteral group, one subject with a P. aeruginosa infection relapsed. Long-term response to therapy was successful for 14 of 19 (74%) subjects who received ofloxacin and 12 of 14 (86%) who received parenteral antibiotics; the difference was not significant. Oral ofloxacin appears comparable to parenteral antibiotics in chronic osteomyelitis due to susceptible organisms, and oral ofloxacin offers advantages in economics and convenience.

Long-Term Follow-Up Trial of Oral Rifampin-Cotrimoxazole Combination versus Intravenous Cloxacillin in Treatment of Chronic Staphylococcal Osteomyelitis

“…Most of the recent successful studies with oral therapies (6,8,9,13,18,20,24,26) have used fluoroquinolones alone or in combinations with rifampin. However, in light of the emergence of resistant S. aureus strains, there is an increasing interest in combinations of rifampin with drugs other than fluoroquinolones.…”

Standard versus Specific Therapy for Chronic Osteomyelitis Treatment

“…A minimum of 4-6 weeks of parenteral antimicrobial therapy targeting the causative organism, in conjunction with surgical debridement, has been proposed as the standard treatment for chronic longbone osteomyelitis in adults [22] . Parenteral therapy consisting of a semi-synthetic penicillin, clindamicin and an aminoglycoside, singly or in combination were considered as being a good regimen [9,27] . In the present study a very simple and relatively low cost therapy regimen is proposed, consisting of up to 15 days of standard parenteral antibiotic treatment with a broad spectrum cephalosporin, hospitalization was kept at a minimum and oral therapy could be performed at home.…”

Influence of rifampin on fleroxacin pharmacokinetics

“…However, this agent is not used as monotherapy because resistance develops rapidly (30,48,49). Quinolones have been used in several clinical studies as single agents in the therapy of staphylococcal infections (12,13,18,19,27). There is also considerable concern about the increasing development of S. aureus resistance to quinolones (6,10,40,42), both during therapy and on the epidemiological level.…”