N. Galanakis et al., CHRONIC OSTEOMYELITIS CAUSED BY MULTIRESISTANT GRAM-NEGATIVE BACTERIA- EVALUATION OF TREATMENT WITH NEWER QUINOLONES AFTER PROLONGED FOLLOW-UP, Journal of antimicrobial chemotherapy, 39(2), 1997, pp. 241-246
We evaluated ciprofloxacin, ofloxacin and pefloxacin regimens for the
treatment of chronic osteomyelitis due to Gram-negative multiresistant
organisms. The study was open, nonrandomized and included 28, 21 and
16 patients, respectively. The 4-fluoroquinolone regimens were 1000 mg
, 400 mg and 400-800 mg bd, for a mean duration of 137, 163 and 134 da
ys, respectively. Pseudomonas aeruginosa was the most common pathogen,
isolated in 33 individuals. Patients were followed clinically, bacter
iologically and radiologically during treatment and for 2-5 years afte
r discontinuation of therapy. Clinical outcome at the end of therapy w
as successful in 79%, 81% and 75%, improvement occurred in 11%, 10% an
d 19%, and the failure rate was 11%, 10% and 6%, while 11%, 5% and 6%
relapsed, respectively. At the end of follow-up the bacterial eradicat
ion rate was 68%, 76% and 69%, respectively. Fluoroquinolone resistanc
e emerged in 18%, 19% and 13% of ciprofloxacin, ofloxacin and pefloxac
in recipients, respectively. The newer quinolones were safe and well t
olerated and should be considered as the contemporary treatment of cho
ice for chronic Gram-negative osteomyelitis, particularly whenever P.
aeruginosa is implicated.