Systemic Antibiotic Therapy for Chronic Osteomyelitis in Adults

Abstract

The standard recommendation for treating chronic osteomyelitis is 6 weeks of parenteral antibiotic therapy. However, oral antibiotics are available that achieve adequate levels in bone, and there are now more published studies of oral than parenteral antibiotic therapy for patients with chronic osteomyelitis. Oral and parenteral therapies achieve similar cure rates; however, oral therapy avoids risks associated with intravenous catheters and is generally less expensive, making it a reasonable choice for osteomyelitis caused by susceptible organisms. Addition of adjunctive rifampin to other antibiotics may improve cure rates. The optimal duration of therapy for chronic osteomyelitis remains uncertain. There is no evidence that antibiotic therapy for >4-6 weeks improves outcomes compared with shorter regimens. In view of concerns about encouraging antibiotic resistance to unnecessarily prolonged treatment, defining the optimal route and duration of antibiotic therapy and the role of surgical debridement in treating chronic osteomyelitis are important, unmet needs.

Six-Week Versus Twelve-Week Antibiotic Therapy for Nonsurgically Treated Diabetic Foot Osteomyelitis: A Multicenter Open-Label Controlled Randomized Study

“…Antibiotics adapted to bone culture results were started as soon as definitive results were available. Antibiotics were selected based on patient comorbidities and were prescribed at doses adapted from those proposed by Spellberg and Lipsky (11). For gram-positive cocci infections, rifampin was used in combination with (by decreasing order of preference) levofloxacin, trimethoprimsulfamethoxazole, doxycycline, linezolid, or any other antimicrobial agent active against bone pathogens for the entire duration of treatment.…”

The microbiology of chronic osteomyelitis in a developing world setting

“…3 Spellberg and Lipsky reviewed publications, from 1970 to 2011, related to the use of antibiotics in chronic osteomyelitis. 11 The authors emphasised the importance of surgical debridement and noted that the cure rate of chronic osteomyelitis is increased with surgical resec tion of infected and devitalised tissue in conjunction with antibiotic therapy. The important conclusions from their review were that oral antibiotic therapy with agents that have high bioavailability is comparable with parenteral therapy; improved cure rates are achieved with the addition of rifampicin; and that the duration of antibiotic therapy should be individualised based on clinical, haematological, and radiological response.…”

“…The important conclusions from their review were that oral antibiotic therapy with agents that have high bioavailability is comparable with parenteral therapy; improved cure rates are achieved with the addition of rifampicin; and that the duration of antibiotic therapy should be individualised based on clinical, haematological, and radiological response. 11 The authors also recommended that antibiotic therapy should be tailored to local sensitivity patterns. The organisms cultured in this series exhibited a wide range of antibiotic sensitivities.…”

A fully functional drug-eluting joint implant

“…Antibiotic penetration into the joint space and bone from systemic administration is limited because of poor blood supply to the infected area [8]. A strategy to address this is to deliver antibiotics locally by incorporating them into orthopaedic implant materials [9, 10].…”