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Article Summary:

The article highlights the problems encountered in managing chronic osteomyelitis, including difficulties in diagnosis, lack of culture data to identify the causative organism, and delays in treatment. Despite the availability of antibiotics, chronic osteomyelitis remains difficult to treat and often relapses after apparent successful treatment. The article reviews studies published since 1970 to address four fundamental questions regarding the treatment of chronic osteomyelitis in adults: the preferred antibiotic choices, the acceptability of oral regimens, the duration of antibiotic therapy, and the necessity of surgical debridement for cure. The pharmacology of osteomyelitis therapy is discussed, including the penetration of various antibiotic agents into bone tissue. The article also examines animal models of chronic osteomyelitis and discusses nonrandomized clinical trials evaluating the effectiveness of parenteral and oral antibiotic therapies. Fluoroquinolones, linezolid, trimethoprim-sulfamethoxazole, clindamycin, rifampin, fusidic acid, and fosfomycin are identified as potential oral treatment options based on their pharmacokinetic properties with preferred options being trimethoprim-sulfamethoxazole and Fluoroquinolones. The article also evaluates the use of Rifampin in combination with other oral agents. The article concludes that while there is limited evidence to determine the best treatment approach for chronic osteomyelitis, several oral antibiotic agents have shown promise. Duration of antibiotics should be individualized from patient to patient and and the importance of surgical debridement and the need for further research in this field are emphasized.