Summary
Emergence ofPseudomonas aeruginosa resistant to antibiotic monotherapy is one of the causes of therapeutic failure in chronicP. aeruginosa osteomyelitis. We report 15 cases of chronic (>3 months of evolution) biopsy culture provenP. aeruginosa osteomyelitis included in an open prospective study evaluating the efficacy of prolonged treatment (>4 months) with two effective antibiotics in combination. Mean post-treatment follow-up was 38 months. A regimen of cefsulodin in combination with oral ofloxacin was used for six patients, cefsulodin-pefloxacin for three patients, cefsulodin-ciprofloxacin for one patient, piperacillin-pefloxacin for one patient, cefsulodin-fosfomycin for one patient, imipenemciprofloxacin for two patients and amoxicillin-ciprofloxacin-fosfomycin for one patient as home therapy. The clinical cure rate of 73% and bacteriological cure rate of 93% are far superior to those previously described in the literature. We did not observe adverse drug reactions. We think that a prolonged use of two effective antibiotics in combination is a safe and improved therapeutic schedule for chronicP. aeruginosa osteomyelitis.
Zusammenfassung
Eine der Ursachen für das Therapieversagen bei chronischerPseudomonas aeruginosa-Osteomyelitis ist die Resistenzentwicklung unter Monotherapie. Wir berichten über 15 Fälle von chronischer, mehr als 3 Monate dauernder bioptisch gesicherterP. aeruginosa-Osteomyelitis, die im Rahmen einer offenen prospektiven Studie mehr als 4 Monate lang mit einer Kombination von zwei aktiven Substanzen behandelt wurden. Die mittlere Verlaufsbeobachtung nach Therapieende beträgt 38 Monate. Sechs Patienten erhielten eine Kombination aus Cefsulodin und oralem Ciprofloxacin, drei Patienten Cefsulodin-Pefloxacin, je ein Patient Cefsulodin-Ciprofloxacin, Piperacillin-Pefloxacin und Cefsulodin-Fosfomycin, zwei Patienten Imipenem-Ciprofloxacin und ein Patient erhielt eine Dreierkombination aus Amoxicillin, Ciprofloxacin und Fosfomycin als Heimtherapie. Die klinische Heilungsrate beträgt 73%, die bakteriologische Eliminationsrate 93%. Die Ergebnisse sind erheblich besser als Daten aus der Literatur. Unerwünschte Nebenwirkungen wurden nicht beobachtet. Die Langzeittherapie mit einer Kombination aus zwei gegenP. aeruginosa wirksamen Antibiotika erscheint uns als sichere und bessere Therapiealternative für die Behandlung der chronischen Pseudomonas-Osteomyelitis.
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References
Bach, M. C., Cocchetto, D. M. Ceftazidime as single-agent therapy for gram-negative aerobic bacillary osteomyelitis. Antimicrob. Agents Chemother. 31 (1987) 1605–1608.
Dan, M., Siegman-Igra, Y., Pitlik, S., Raz, R. Oral ciprofloxacin treatment ofPseudomonas aeruginosa osteomyelitis. Antimicrobial Agents Chemother. 34 (1990) 849–852.
Dellamonica, P., Bernard, E., Etesse, H., Garaffo, R., Drugeon, M. B. Evaluation of pefloxacin, ofloxacin and ciprofloxacin in the treatment of thirty-nine cases of chronic osteomyelitis. Eur. J. Clin. Microbiol. Infect. Dis. 8 (1989) 1024–1030.
Desplaces, N., Acar, J. F. New quinolones in the treatment of joint and bone infections. Rev. Infect. Dis. 10 (Suppl. 1) (1988) 179–183.
Etropoulos, G. M., Etropoulos, C. T. Ciprofloxacin in combination with other antimicrobials. Am. J. Med. 87 (Suppl. 5 A) (1989) 17–22.
Gentry, L. O., Rodriguez, G. C. Oral ciprofloxacin compared with parenteral antibiotics in the treatment of osteomyelitis. Antimicrob. Agents Chemother. 34 (1990) 40–43.
Gentry, L. O. Treatment of skin, skin structure, bone and joint infections with ceftazidime. Am. J. Med. 79 (Suppl. 2 A) (1985) 67–74.
Giamarellou, H., Galanakis, N., Dendrinos, C., Stefanov, J., Daphnis, E., Daikos, G. K. Evaluation of ciprofloxacin in the treatment ofPseudomonas aeruginosa infections. Eur. J. Clin. Microbiol. 5 (1986) 232–235.
Gilbert, D. N., Tice, A. D., Marsh, P. K., Craven, P. C., Preheim, L. C. Oral ciprofloxacin therapy for chronic osteomyelitis caused by aerobic gram-negative bacilli. Am. J. Med. 82 (Suppl. 4 A) (1987) 254–258.
Greenberg, R. N., Tice, A. D., Marsh, P. K., Craven, P. C., Reilly, P. M., Bollinger, M., Weinandt, W. J. Randomized trial of ciprofloxacin compared with other antimicrobial therapy in the treatment of osteomyelitis. Am. J. Med. 82 (Suppl. 4 A) (1987) 266–269.
Gudiol, F., Cabellos, C., Pallares, R., Linares, J., Ariza, J. Intravenous ciprofloxacin in severe infections. Am. J. Med. 87 (Suppl. 5 A) (1989) 221–224.
Korvick, J., Yu, V. L. Antimicrobial therapy forPseudomonas aeruginosa. Antimicrob. Agents Chemother. 35 (1991) 2167–2172.
Lang, R., Lishner, M., Ravid, M. Adverse reactions to prolonged treatment with high doses of carbenicillin and ureidopenicillins. Rev. Infect. Dis. 13 (1991) 68–72.
Lesse, A. J., Freer, C., Salata, R. A., Francis, J. B., Scheld, W. M. Oral ciprofloxacin therapy for gram-negative bacillary osteomyelitis. Am. J. Med. 82 (Suppl. 4 A) (1987) 247–253.
Lucht, R. F., Vergely, N., Rousset, H., Bousquet, G., Balique, J. G. Totally implantable vascular access for antimicrobial infusion at home and prevention of systemic candidosis. Lancet i (1989) 666.
MacGregor, R. R., Gentry, L. O. Imipenem/cilastatin in the treatment of osteomyelitis. Am. J. Med. 78 (Suppl. 6 A) (1985) 100–103.
Norden, C. W., Niederreiter, K. Ofloxacin therapy for experimental osteomyelitis caused byPseudomonas aeruginosa. J. Infect. Dis. 155 (1987) 823–825.
Norden, C. W., Shinners, E. Ciprofloxacin as therapy for experimental osteomyelitis caused byPseudomonas aeruginosa. J. Infect. Dis. 151 (1985) 291–294.
Sculy, B. E., Neu, H. C., Pany, M. F., Mandell, D. W. Oral ciprofloxacin therapy of infections due toPseudomonas aeruginosa. Lancet i (1986) 819–822.
Slama, T. G., Misinski, J., Sklar, S. Oral ciprofloxacin therapy for osteomyelitis caused by aerobic gram-negative bacilli. Am. J. Med. 82 (Suppl. 4 A) (1987) 259–261.
Trexler-Hessen, M., Levinson, M. E. Ciprofloxacin for the treatment of osteomyelitis: a review. J. Foot Surg. 28 (1987) 100–105.
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Lucht, R.F., Fresard, A., Berthelot, P. et al. Prolonged treatment of chronicPseudomonas aeruginosa osteomyelitis with a combination of two effective antibiotics. Infection 22, 276–280 (1994). https://doi.org/10.1007/BF01739916
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DOI: https://doi.org/10.1007/BF01739916