PROLONGED TREATMENT OF CHRONIC PSEUDOMONAS-AERUGINOSA OSTEOMYELITIS WITH A COMBINATION OF 2 EFFECTIVE ANTIBIOTICS

Emergence of Pseudomonas aeruginosa resistant to antibiotic monotherap y is one of the causes of therapeutic failure in chronic P. aeruginosa osteomyelitis. We report 15 cases of chronic (> 3 months of evolution ) biopsy culture proven P. aeruginosa osteomyelitis included in an ope n prospective study evaluating the efficacy of prolonged treatment (> 4 months) with two effective antibiotics in combination. Mean post-tre atment follow-up was 38 months. A regimen of cefsulodin in combination with oral ofloxacin was used for six patients, cefsulodin-pefloxacin for three patients, cefsulodin-ciprofloxacin for one patient, piperaci llin-pefloxacin for one patient, cefsulodin-fosfomycin for one patient , imipenem-ciprofloxacin for two patients and amoxicillin-ciprofloxaci n-fosfomycin for one patient as home therapy. The clinical cure rate o f 73% and bacteriological cure rate of 93% are far superior to those p reviously described in the literature. We did not observe adverse drug reactions. We think that a prolonged use of two effective,antibiotics in combination is a safe and improved therapeutic schedule for chroni c P. aeruginosa osteomyelitis.