Treatment of Osteomyelitis and Septic Arthritis

Abstract

This chapter summarizes the current knowledge of the use of quinolones in the treatment of osteomyelitis and septic arthritis. The identification of the causative organisms of osteomyelitis is essential for diagnosis and treatment. It is important to obtain deep specimens, in particular by bone biopsy, for microbiological and pathological analysis. The specific organism isolated in bacterial osteomyelitis is often associated with the age of the patient, a common clinical presentation (i.e., trauma or recent surgery), and the presence or absence of vascular insufficiency. Staphylococcus aureus is found in most patients with acute hematogenous osteomyelitis. Staphylococcus epidermidis, S. aureus, Pseudomonas aeruginosa, Enterobacteriaceae (Serratia marcescens and Escherichia coli) are commonly isolated in patients with chronic osteomyelitis. The rabbit model of P. aeruginosa chronic osteomyelitis has the relative advantage of assessing the rate of negative microbiological cultures after 3 to 4 weeks of therapy. Several recent studies show interesting results concerning the potential utilization of quinolones in local drug-carrier systems that allow high local antibiotic concentrations to be achieved. Several recent reviews of the use of various agents in the therapy of osteomyelitis have reported that among the quinolones presently available, ciprofloxacin, ofloxacin, and pefloxacin have been used most often in large series of patients with bacterial osteomyelitis. The combination of quinolones with rifampin for the treatment of staphylococcal osteomyelitis appears promising.