Treatment of chronic osteomyelitis with ciprofloxacin.

Twenty-seven patients with chronic osteomyelitis were treated with oral ciprofloxacin, 500 mg (13 patients) or 750 mg (13) twice daily and one patient was treated with 300 mg twice daily intravenously. Treatment was given for 17-189 days (mean 69). Twenty-three patients had prosthetic implants, 16 patients had infections caused by one bacterium and 11 had polymicrobial infections. The predominant organisms were strains of Enterobacteriaceae, Pseudomonas aeruginosa and Staphylococcus aureus. Cure was obtained in 20 patients and improvement in four. Three patients failed to respond to therapy. Concentrations of ciprofloxacin, measured in pus 1 h after 500 mg orally ranged from 0.6-1.3 mg/l, whilst 2 h after 750 mg orally concentrations of 2.4-6.8 mg/l were found. Sterilization of pus and closure of infected wounds or draining sinuses were observed within four weeks of treatment in the majority of patients. Ciprofloxacin was well tolerated in 26 patients, whilst one had severe nausea after oral administration.