Osteomyelitis due to methicillin-resistant successfully treated by an oral combination of minocycline and trimethoprim-sulfamethoxazole.

Most of the anti-methicillin-resistant drugs available in Japan are administered intravenously, except for linezolid, which can also be administered orally. Here, we report a lupus patient with methicillin-resistant induced osteomyelitis. Linezolid had to be stopped due to severe anemia. In an effort to treat her on an outpatient basis, we planned to use a combination of minocycline and trimethoprim-sulfamethoxazole that exhibited in vitro sensitivity against the methicillin-resistant detected, and rifampicin is used against methicillin-resistant in certain cases. The use of rifampicin increased the level of C-reactive protein even though the prednisolone dose used was doubled, so we gave up using it. The combined application of oral minocycline and trimethoprim-sulfamethoxazole, however, controlled the inflammation, and the patient was able to be discharged. Fourteen months later, we discontinued the administration of both drugs and there has been no relapse more than a year. This combination of antibiotics may be useful, especially when patients want to be treated on an outpatient basis.