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.
Highlights
The standard recommendation for treating chronic osteomyelitis is 6 weeks of parenteral antibiotic therapy
What have we learned about treating chronic osteomyelitis in the past few decades? Previous reviews of this topic have concluded that available literature is inadequate to determine the best agent, route, or duration
In a salvage study of patients with methicillin-resistant Staphylococcus aureus (MRSA) osteomyelitis that had failed to respond to previous therapy, all 9 patients who were treated with daptomycin had clinical resolution of their
Summary
The standard recommendation for treating chronic osteomyelitis is 6 weeks of parenteral antibiotic therapy. Oral antibiotics are available that achieve adequate levels in bone, and there are more published studies of oral than parenteral antibiotic therapy for patients with chronic osteomyelitis. 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. Perhaps the earliest known case of chronic osteomyelitis dates to the Permian era, in an unfortunate dimetrodon that developed infection in a fractured spinal shaft [1]. Undeterred, we set out to review studies published since 1970 in an attempt to address 4 fundamental questions regarding treatment of chronic osteomyelitis in adults: (1) Are certain antibiotic agents preferred choices? We reviewed all articles if they, or at least their abstracts, were in English
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