Ciprofloxacin in the treatment of acute and chronic osteomyelitis: a review.

The clinical and bacteriological efficacy and safety of ciprofloxacin given as oral doses of 500 to 1,500 mg (normally 750 mg) twice daily for treatment of Gram-negative bacillary osteomyelitis are reviewed. In 182 patients of whom a majority had Pseudomonas aeruginosa or mixtures of Ps. aeruginosa and other bacteria as the causative agents, clinical cure or improvement was achieved in 75%. Data from 85 patients with Ps. aeruginosa as the infecting pathogen could be analysed and showed that 20 strains persisted and that nine of them became resistant to ciprofloxacin during treatment. In patients with Staphylococcus aureus as a copathogen, that organism was eradicated during ciprofloxacin treatment in more than 90% of the cases. Despite very long treatment times (up to 476 days), the safety of ciprofloxacin seemed comparable to that reported with shorter treatment times and lower doses. However, it was noted that three patients developed photosensitization during treatment and that reversible renal failure related to ciprofloxacin occurred in one patient. In conclusion, ciprofloxacin offers a well tolerated and efficacious alternative to injectable antibiotics for the treatment of Gram-negative osteomyelitis.