Role of oral antimicrobial therapy in the management of osteomyelitis

Abstract

The standard of care for chronic osteomyelitis in adults remains intravenous antimicrobial therapy, in combination with surgery, for at least 4-6 weeks. Acute osteomyelitis in the pediatric population as well as osteomyelitis caused by atypical Gram-positive organisms and some Gram-negative organisms may be treated successfully with oral antibiotics. Some antimicrobials have equivalent concentration in serum whether administered orally or parenterally. When therapy with these antimicrobials is indicated, the oral route is preferred in compliant patients. As research continues in this area and as new drug formulations are developed, oral therapy may become an accepted alternative in additional selected patients.

Treatment of spondylodiscitis

“…as is the case with fluoroquinolones, clindamycin, or linezolid. Linezolid is mainly used in cases of MRSA infection, although one should be aware of the haematopoietic side effects [6,18,19].…”

Efficacy of Ciprofloxacin-Releasing Bioabsorbable Osteoconductive Bone Defect Filler for Treatment of Experimental Osteomyelitis Due to Staphylococcus aureus

“…The treatment keystones are radical surgical debridement of the infected tissues, obliteration of the dead space, adequate soft tissue coverage, and a minimum of 4 to 6 weeks of intravenous antimicrobial therapy (3,35). However, there are still significant relapse rates, even with such vigorous treatment programs; and therefore, alternative strategies have been introduced.…”

Inadvisable Treatment of Recalcitrant Septic Olecranon Bursitis: An Unusual Case of Extremely Prolonged Treatment With Oral Antibiotics After Bursectomy

“…Although successful treatment of acute osteomyelitis with long-term oral antibiotics is a well established form of treatment [15,16] and successful treatment of recalcitrant or virulent bacterial infections with oral trimethoprim/sulfamethoxazole alone or concurrently with rifampin have been described [17][18][19][20], we could not locate a case of septic OB (with or without olecranon osteomyelitis) that required using these two antibiotics with prolonged duration similar to that required for our patient. Scully and co-workers [21] reported on the prolonged use (mean 40 days, range: 5 -283 days) of oral ofloxacin for infections due to multiple-resistant bacteria, including Staphylococcus aureus.…”