Skip to main content
Log in

Antiinfektive Therapie der Osteomyelitis

Anti-infective therapy of osteomyelitis

  • Leitthema
  • Published:
Der MKG-Chirurg Aims and scope

Zusammenfassung

Die Paul-Ehrlich-Gesellschaft hat interdisziplinäre Empfehlungen zur kalkulierten Antibiotikatherapie formuliert, die für die Behandlung der Kieferosteomyelitis bedeutsam sind. Auf Basis dieser Empfehlungen wird in diesem Artikel der aktuelle Stand der klinischen Anwendung von Antibiotika bei Kieferosteomyelitis dargestellt. Eine zentrale Rolle spielen auch weiterhin die β-Lactam-Antibiotika. Wegen der Langzeittherapie muss jedoch in besonderem Maße an mögliche Nebenwirkungen gedacht werden.

Abstract

The Paul-Ehrlich-Institut has formulated interdisciplinary recommendations for calculated antibiotic therapy which are important for the treatment of osteomyelitis of the jaws. Based on these recommendations this article presents the current state of the clinical administration of antibiotics for osteomyelitis of the jaws. The beta-lactam antibiotics continue to play a central role; however, special consideration must also be given to possible side effects due to the long-term therapy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Literatur

  1. Bodmann K-F, Grabein B und die Expertenkommission der Paul-Ehrlich-Gesellschaft für Chemotherapie e. V. (2010) Empfehlungen zur kalkulierten parenteralen Initialtherapie bakterieller Erkrankungen bei Erwachsenen. Update 2010. Chemother J 19:179–255

    Google Scholar 

  2. Al-Nawas B, Kaemmerer P (2009) Infektionen im Kiefer-Gesichtsbereich – Osteomyelitis. MKG Chir 2:221–232

    Article  Google Scholar 

  3. Baltensperger M, Gratz K, Bruder E et al (2004) Is primary chronic osteomyelitis a uniform disease? Proposal of a classification based on a retrospective analysis of patients treated in the past 30 years. J Craniomaxillofac Surg 32:43–50

    Article  PubMed  Google Scholar 

  4. Assmann G, Wagner AD, Monika M et al (2010) Single-nucleotide polymorphisms p53 G72C and Mdm2 T309G in patients with psoriasis, psoriatic arthritis, and SAPHO syndrome. Rheumatol Int 30:1273–1276

    Article  PubMed  CAS  Google Scholar 

  5. Frid P, Tornes K, Nielsen O, Skaug N (2009) Primary chronic osteomyelitis of the jaw – a microbial investigation using cultivation and DNA analysis: a pilot study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 107:641–647

    Article  PubMed  Google Scholar 

  6. Al-Nawas B, Grötz KA, Piesold J (2008) Leitlinien der Deutschen Gesellschaft für Mund-, Kiefer- und Gesichtschirurgie – Osteomyelitis S2. http://www.awmf.org/uploads/tx_szleitlinien/007-045_S2_Osteomyelitis_abgelaufen.pdf

  7. Kesting MR, Thurmuller P, Ebsen M, Wolff KD (2008) Severe osteomyelitis following immediate placement of a dental implant. Int J Oral Maxillofac Implants 23:137–142

    PubMed  Google Scholar 

  8. Handschel J, Brussermann S, Depprich R et al (2007) Evaluation of hyperbaric oxygen therapy in treatment of patients with osteomyelitis of the mandible. Mund Kiefer Gesichtschir 11:285–290

    Article  PubMed  Google Scholar 

  9. Wipff J, Adamsbaum C, Kahan A, Job-Deslandre C (2011) Chronic recurrent multifocal osteomyelitis. Joint Bone Spine 78:555–560

    Article  PubMed  Google Scholar 

  10. Armstrong DJ, Wright SA, Coward SM, Finch MB (2006) Bone marker response in chronic diffuse sclerosing osteomyelitis treated with intravenous ibandronate. Ann Rheum Dis 65:976–977

    Article  PubMed  CAS  Google Scholar 

  11. Hino S, Murase R, Terakado N et al (2005) Response of diffuse sclerosing osteomyelitis of the mandible to alendronate: follow-up study by 99mTc scintigraphy. Int J Oral Maxillofac Surg 34:576–578

    Article  PubMed  CAS  Google Scholar 

  12. Pigrau C, Almirante B, Rodriguez D et al (2008) Osteomyelitis of the jaw: resistance to clindamycin in patients with prior antibiotics exposure. Eur J Clin Microbiol Infect Dis 28:317–323

    Article  PubMed  Google Scholar 

  13. Ang JY, Asmar BI (2008) Multidrug-resistant viridans streptococcus (MDRVS) osteomyelitis of the mandible successfully treated with moxifloxacin. South Med J 101:539–540

    Article  PubMed  Google Scholar 

  14. Tuzuner-Oncul AM, Ungor C, Dede U, Kisnisci RS (2009) Methicillin-resistant Staphylococcus aureus (MRSA) osteomyelitis of the mandible. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 107:e1–e4

    PubMed  Google Scholar 

  15. Antony B, Thomas S, Chandrashekar SC et al (2009) Osteomyelitis of the mandible due to Aggregatibacter (Actinobacillus) actinomycetemcomitans. Indian J Pathol Microbiol 52:115–116

    Article  PubMed  Google Scholar 

  16. Pappalardo S, Tanteri L, Brutto D et al (2008) Mandibular osteomyelitis due to Pseudomonas aeruginosa. Case report. Minerva Stomatol 57:323–329

    PubMed  CAS  Google Scholar 

  17. Coviello V, Stevens MR (2007) Contemporary concepts in the treatment of chronic osteomyelitis. Oral Maxillofac Surg Clin North Am 19:523–534, vi

    Article  PubMed  Google Scholar 

  18. Robinson JL, Vaudry WL, Dobrovolsky W (2005) Actinomycosis presenting as osteomyelitis in the pediatric population. Pediatr Infect Dis J 24:365–369

    Article  PubMed  Google Scholar 

  19. Bartkowski SB, Zapala J, Heczko P, Szuta M (1998) Actinomycotic osteomyelitis of the mandible: review of 15 cases. J Craniomaxillofac Surg 26:63–67

    Article  PubMed  CAS  Google Scholar 

  20. Kumar SK, Gorur A, Schaudinn C et al (2010) The role of microbial biofilms in osteonecrosis of the jaw associated with bisphosphonate therapy. Curr Osteoporos Rep 8:40–48

    Article  PubMed  Google Scholar 

  21. Sedghizadeh PP, Kumar SK, Gorur A et al (2009) Microbial biofilms in osteomyelitis of the jaw and osteonecrosis of the jaw secondary to bisphosphonate therapy. J Am Dent Assoc 140:1259–1265

    PubMed  Google Scholar 

  22. Assmann G, Kueck O, Kirchhoff T et al (2009) Efficacy of antibiotic therapy for SAPHO syndrome is lost after its discontinuation: an interventional study. Arthritis Res Ther 11:R140

    Article  PubMed  Google Scholar 

  23. Kluin OS, Mei HC van der, Busscher HJ, Neut D (2013) Biodegradable vs non-biodegradable antibiotic delivery devices in the treatment of osteomyelitis. Expert Opin Drug Deliv 10(3):341–351

    Article  PubMed  CAS  Google Scholar 

  24. Bode LG, Kluytmans JA, Wertheim HF et al (2010) Preventing surgical-site infections in nasal carriers of Staphylococcus aureus. N Engl J Med 362:9–17

    Article  PubMed  CAS  Google Scholar 

  25. Gresser U (2001) Amoxicillin-clavulanic acid therapy may be associated with severe side effects – review of the literature. Eur J Med Res 6:139–149

    PubMed  CAS  Google Scholar 

  26. Otten JE, Weingart D, Hilger Y et al (1991) Penicillin concentration in the compact bone of the mandible. Int J Oral Maxillofac Surg 20:310–312

    Article  PubMed  CAS  Google Scholar 

  27. Landersdorfer CB, Kinzig M, Bulitta JB et al (2009) Bone penetration of amoxicillin and clavulanic acid evaluated by population pharmacokinetics and Monte Carlo simulation. Antimicrob Agents Chemother 53:2569–2578

    Article  PubMed  CAS  Google Scholar 

  28. Al-Nawas B, Kinzig-Schippers M, Sörgel F, Shah PM (2008) Concentrations of Piperacillin Tazobactam in human jaw and hip bone. J Craniomaxillofac Surg 36:468–472

    Article  PubMed  Google Scholar 

  29. Grötz KA, Piesold J, Al-Nawas B (2012) AWMF S3 Leitlinie: Bisphosphonat-assoziierte Kiefernekrose (BP-ONJ) und andere Medikamenten-assoziierte Kiefernekrosen. http://www.awmf.org/uploads/tx_szleitlinien/007-091l_S3_Bisphosphonat-assoziierte_Kiefernekrose_2012-04.pdf

  30. Piesold J, Al-Nawas B, Grötz KA (2008) Leitlinien der Deutschen Gesellschaft für Mund-, Kiefer- und Gesichtschirurgie – Infizierte Osteoradionekrose. http://www.awmf.org/uploads/tx_szleitlinien/007-046_S2_Infizierte_Osteoradionekrose_abgelaufen.pdf

  31. Mueller SC, Henkel KO, Neumann J et al (1999) Perioperative antibiotic prophylaxis in maxillofacial surgery: penetration of clindamycin into various tissues. J Craniomaxillofac Surg 27:172–176

    Article  PubMed  CAS  Google Scholar 

  32. Metallidis S, Topsis D, Nikolaidis J et al (2007) Penetration of moxifloxacin and levofloxacin into cancellous and cortical bone in patients undergoing total hip arthroplasty. J Chemother 19:682–687

    PubMed  CAS  Google Scholar 

  33. Malincarne L, Ghebregzabher M, Moretti MV et al (2006) Penetration of moxifloxacin into bone in patients undergoing total knee arthroplasty. J Antimicrob Chemother 57:950–954

    Article  PubMed  CAS  Google Scholar 

  34. Cachovan G, Nergiz I, Thuss U et al (2009) Penetration of moxifloxacin into rat mandibular bone and soft tissue. Acta Odontol Scand 67:182–186

    Article  PubMed  CAS  Google Scholar 

  35. Warnke PH, Becker ST, Springer IN et al (2008) Penicillin compared with other advanced broad spectrum antibiotics regarding antibacterial activity against oral pathogens isolated from odontogenic abscesses. J Craniomaxillofac Surg 36:462–467

    Article  PubMed  Google Scholar 

  36. Al-Nawas B, Walter C, Morbach T et al (2008) Clinical and microbiological efficacy of moxifloxacin versus amoxicillin/clavulanic acid in severe odontogenic abscesses – a pilot study. Eur J Clin Microbiol Infect Dis 28:75–82

    Article  PubMed  Google Scholar 

  37. Swantes J, Al-Nawas B, Shah PM (2002) In-vitro-Aktivität von Clindamycin, Rifampicin und Rifabutin gegenüber intra- und extrazellulären Staphylokokken unterschiedlicher Resistenzmuster. Chemother J 11:143–147

    Google Scholar 

  38. Schierholz JM, Rump A, Pulverer G (1996) Drug delivery concepts for the efficacious prevention of foreign-body infections. Zentralbl Bakteriol 284:390–401

    Article  PubMed  CAS  Google Scholar 

Download references

Interessenkonflikt

Keine Angaben.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to B. Al-Nawas.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Al-Nawas, B. Antiinfektive Therapie der Osteomyelitis. MKG-Chirurg 6, 88–91 (2013). https://doi.org/10.1007/s12285-012-0323-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12285-012-0323-x

Schlüsselwörter

Keywords

Navigation