Antimicrobial therapy for chronic osteomyelitis in adults: role of the quinolones.

The development of antimicrobial therapy for osteomyelitis is reviewed. The disease, especially when chronic, is notoriously resistant to antibiotic therapy. The duration of disease defining chronicity has decreased considerably in the last 30 years. Successful therapy reflects increased appreciation of the combined roles of surgical debridement and prolonged antimicrobial courses. Parenteral high-dose beta-lactam agents yield clinical success for many patients with chronic osteomyelitis, particularly with prolonged administration and surgical debridement. Over the last decade, the initial success of oral quinolone therapy for gram-negative osteomyelitis was exploited further for staphylococcal diseases. Open clinical trials and comparative trials suggest success rates approximating those achieved with parenteral beta-lactams, particularly with appropriate surgery and adequate duration of therapy. The early results with quinolones and rifampin for prosthesis-related infection are encouraging. Overall, oral quinolones provide a new and frequently proportionate response to a disease that is difficult to treat.