Use of quinolones in osteomyelitis and infected orthopaedic prosthesis

The present review provides an updated critical analysis of the use of quin olones in osteomyelitis and orthopaedic prosthetic infections. Only papers published in peer-reviewed journals and related to the following areas were selected: experimental osteomyelitis, penetration of quinolones into human bone, and clinical use in comparative and noncomparative studies. Local dr ug carriers impregnated with quinolones allow high local antibiotic concent rations to be achieved in experimental systems. Considerable clinical exper ience has been gained mostly with ciprofloxacin and ofloxacin. Cumulated re sults in clinical trials show clinical success rates of more than 90% in os teomyelitis caused by Enterobacteriaceae. The combination of quinolones and rifampicin for the treatment of staphylococcal osteomyelitis as well as or thopaedic prosthetic infections appears very promising in clinical studies with a small number of patients. However, further comparative studies using quinolones as single agents or in combination (versus standard parenteral therapy) remain necessary in osteomyelitis due to Staphylococcus aureus or Pseudomonas aeruginosa. In particular, studies with the newer quinolones sh ould be strongly encouraged in acute or chronic osteomyelitis and in more c omplicated situations such as diabetic osteomyelitis or foreign-body infect ion.