Antibiotics for treating chronic osteomyelitis in adults

Abstract

Limited and low quality evidence suggests that the route of antibiotic administration (oral versus parenteral) does not affect the rate of disease remission if the bacteria are susceptible to the antibiotic used. However, this and the lack of statistically significant differences in adverse effects need confirmation. No or insufficient evidence exists for other aspects of antibiotic therapy for chronic osteomyelitis.The majority of the included trials were conducted over 20 years ago and currently we are faced with a far higher prevalence of bacteria that are resistant to many of the available antibiotics used for healthcare. This continuously evolving bacterial resistance represents another challenge in the choice of antibiotics for treating chronic osteomyelitis.

New and updated reviews published by the Cochrane collaboration.

“…No signifi cant diff erence was found in the incidence of adverse events for each administration route. 2 While the authors found no diff erences in their outcome measures, they felt there was insuffi cient evidence to draw any conclusions from what were outdated studies with small numbers and at moderate to high risk of bias. Clearly, antibiotic therapy has a role to play in the control of chronic infection but we still do not have the answers for optimal administration route or duration.…”

“…This review focuses in particular on the choice of antimicrobial, the optimal route of administration and duration of therapy. 2 The authors performed the usual extensive Cochrane literature review but were able to include only eight small studies in total, of which only four were appropriate for inclusion in the meta-analysis. The included trials evaluated fi ve diff erent antibiotic comparisons (oral versus parenteral, parenteral then oral versus oral only, parenteral then oral versus parenteral only, oral versus another oral, parenteral versus another parenteral).…”

“…The review team were unable to fi nd any RCTs that looked specifi cally at the duration of antibiotics. 2 The authors found the data across the trials too heterogeneous to draw comparisons between antibiotics and establish the best antibiotic choice.…”

d-amino Acid Inhibits Biofilm but not New Bone Formation in an Ovine Model

“…Treatment of bone infections in patients with fractures can involve operative débridement of necrotic bone followed by several weeks of systemic antibiotics, temporary fixation, and/or implantation of devices to promote bone regeneration [11,44]. For orthopaedic infections, Staphylococcus aureus is the most commonly isolated agent, accounting for more than 1 . 2 of all infections [28].…”

“…Bacterial biofilms are a protected mode of growth characterized by a high tolerance to the activity of antimicrobials compared with planktonic bacteria, which is partly attributable to the limited permeability of antimicrobials through the extracellular matrix surrounding the bacteria and the reduced metabolic state of the persister cells in the biofilm [11,28,44,50]. Although clinical studies have underscored the relationship between infection and nonunion of diaphyseal fractures [24], periarticular fractures also have high rates of infections complications.…”