not many studies have examined the ...

not many studies have examined the issue of prolonged intravenous antimicrobial therapy in the treatment of osteomyelitis, partly because this disease is in transition. As the U population has aged, the prevalence of diabetes and peripheral vascular disease has increased. These diseases predispose patients to unfold osteomyelitis and are complicating factors in its treatment. The number of infections after joint replacements or network surgical interventions also has increased, and newer surgical interventions and antibiotics, including outpatient parenteral therapy, are being used. The present regimen for the treatment of osteomyelitis is four weeks of high-dosage intravenous therapy. Tice and associates studied the weights of diabetes, peripheral vascular disease, age, and antimicrobial therapy in succession clinical outcomes in patients with osteomyelitis treated in the outpatient setting.

The close attention design was a retrospective chart review of patients treated for osteomyelitis in an infectious disease clinic. The review included patients diagnosed with osteomyelitis who were seen from January 1982 in consequence of April 1998. Inclusion criteria included identification of the same clear pathogen by initial cultivation results, treatment with at least 14 continuous days of antimicrobial therapy, treatment with no more than brace antimicrobial agents, and follow-up for at least six month Standard antimicrobial therapy in patients with normal renal function included 2 g of a penicillinase-resistant penicillin of the like kind as oxacillin, nafcillin, or methicillin each six hours; 2 g of cefazolin each eight hours; 2 g of ceftriaxone each 24 hours; or 1 g of vancomycin each 12 to 24 hours. Patients were identified as cur or having a resort which was defined as an infection in the same site after the original infection apparently had been eliminated. The the having recourses were further divided into relapse if the infection was with the original pathogen, or reinfection if the organism was different.

A total of 454 patients met the inclusion criteria and were included in the application of mind Of these patients, 31 percent had the having recourses and 6 percent had amputations. More than three fourths of the returns occurred in the first six month and 95 percent occurr in the first 12 month after the initial infection. Peripheral vascular disease and diabetes were associated with the risk of recurrence; age was not. Patients with Staphylococcus aureus infection who took ceftriaxone and cefazolin had a risk for resort similar to that of patients taking the penicillinase-resistant penicillins. Compared with patients taking penicillinase-resistant penicillins, patients who took vancomycin had a relative risk of the having recourse of 2.5. The authors deduce that diabetes and peripheral vascular disease are risk factors for developing returning osteomyelitis. Most recurrences occur within the first year after treatment. resort rates for S. aureus osteomyelitis were higher in patients who originally took vancomycin. This point may be related to findings from a inquiry suggesting that vancomycin may be les effective against methicillin-susceptible strains of staphylococci.

Tice AD, et al. results of osteomyelitis among patients treated with outpatient parenteral antimicrobial therapy. Am J M June 15 2003;114:723-8

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