Clinical utility of new quinolones in treatment of osteomyelitis and lower respiratory tract infections

  • A. S. Bayer
Current Topic: Review

Abstract

In the eight major clinical studies published on use of oral quinolones in therapy of contiguous osteomyelitis, clinical and microbiologic cure/improvement rates were 75 % and 73 %, respectively, when drug therapy was combined with appropriate surgical debridement. This included many cases of polymicrobial osteomyelitis, as well as infection caused by recalcitrant pathogens such asPseudomonas aeruginosa. In contrast, the response of staphylococcal osteomyelitis to oral quinolones, especially in cases caused by methicillin-resistant strains, appeared suboptimal. Quinolones appear to have a limited role in the treatment of community-acquired pneumonia, since other established antibiotic regimens have been proven effective in such situations. Quinolones may play an important role in the treatment of nosocomially acquired aerobic gram-negative bacillary pneumonia, either as primary parenteral therapy or as transitional oral therapy when affected patients become outpatients. In cystic fibrosis-associated acute exacerbations of chronic pseudomonal pneumonitis, the outcome of oral ciprofloxacin therapy was very satisfactory in the six major studies reported (∼ 85 % improvement rates). In three comparative studies oral quinolone treatment of such pulmonary exacerbations resulted in clinical response rates equivalent to those for aminoglycoside plusβ-lactam therapy given intravenously. Quinolone-resistantPseudomonas aeruginosa strains were commonly isolated from sputum during treatment; however, such patients continued to respond clinically to quinolone treatment, and sputum became rapidly repopulated with quinolone-susceptiblePseudomonas aeruginosa strains after discontinuation of therapy.

Keywords

Osteomyelitis Aminoglycoside Lower Respiratory Tract Infection Surgical Debridement Clinical Response Rate 

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Copyright information

© Friedr. Viewey & Sohn Verlagsgesellschaft mbH 1989

Authors and Affiliations

  • A. S. Bayer
    • 1
  1. 1.University of California at Los Angeles School of MedicineAdult Infectious Diseases, and Harbor-UCLA Medical CenterTorranceUSA

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