amoxicillin-potassium-clavulanate-combination and Osteomyelitis

The science of antibiotic therapy for infectious diseases continues to evolve. In many instances where empiric coverage is necessary, treatment with more than one agent is considered prudent. If an etiology is identified, antibiotics are modified based on culture and susceptibility data. Even when the organism is known, more than one antibiotic may be needed. Decisions about antibiotics should be made after assessments of pertinent clinical information, laboratory and microbiology information, ease of administration, patient compliance, potential adverse effects, cost, and available evidence supporting various treatment options. Clinicians also need to consider synergy and local resistance patterns in selecting therapeutic options. In this article, the authors outline monotherapy and combination therapy options for several common infectious diseases.

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bacterial Infections; Cellulitis; Cephalosporins; Ciprofloxacin; Diverticulitis; Drug Therapy, Combination; Endocarditis, Bacterial; Enterococcus faecalis; Humans; Meningitis, Bacterial; Neutropenia; Osteomyelitis; Pneumonia; Staphylococcus aureus; Viridans Streptococci

Streptococcus agalactiae is a rare cause of vertebral osteomyelitis. We present four cases of spondylitis caused by this micro-organism and a review of 20 cases previously described in the literature. Only seven patients (29%) were under 50 years of age. Diabetes mellitus and neoplasms were the most frequent underlying conditions, although 37.5% of the patients did not have any predisposition. Neck or back pain was the most common symptom. Diagnosis depended mainly on magnetic resonance imaging. Blood cultures were positive in 50% of the patients. The duration of antibiotic therapy was 6 weeks for most patients. The outcome was favourable, with none of the patients suffering serious sequelae.

Topics: Abscess; Aged; Amoxicillin-Potassium Clavulanate Combination; Ampicillin; Arthroplasty, Replacement, Hip; Cefazolin; Cephalosporins; Drug Therapy, Combination; Female; Gentamicins; Hemoglobins; Humans; Leukocyte Count; Lumbar Vertebrae; Magnetic Resonance Imaging; Male; MEDLINE; Middle Aged; Osteomyelitis; Penicillins; Radiography; Spondylitis; Streptococcal Infections; Streptococcus agalactiae

The chronic diffuse sclerosing osteomyelitis (CDSO) of the mandible has been described as an inflammatory disease characterized by recurrent episodes of intense pain in the mandible, often accompanied by trismus, paresthesia and progressive mandibular deformity. The etiopathogeny of this entity is not fully known. The differential diagnosis must be carried out very carefully, and the treatment results are very disappointing. Recently, evidence that suggests that CDSO may be the mandibular location of a more diffuse condition, the synovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO) syndrome, has been offered. We describe two clinical cases of CDSO of typical evolution which fulfill the criteria for SAPHO syndrome, offering us an occasion for a review of the current literature.

Topics: Acne Vulgaris; Adult; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Anti-Inflammatory Agents, Non-Steroidal; Chronic Disease; Clavulanic Acids; Diagnosis, Differential; Drug Therapy, Combination; Follow-Up Studies; Humans; Hyperostosis; Male; Mandibular Diseases; Middle Aged; Osteitis; Osteomyelitis; Penicillin V; Penicillins; Psoriasis; Sclerosis; Syndrome; Synovitis

Actinomycosis is a rare infectious disease caused by Actinomyces, especially in children. Here, we present a case of musculoskeletal actinomycosis in a 5-year-old girl from China.. A 5-year-old girl presented with recurrent episodes of fever, pain, erythema, swelling, and festering sores on the right lower extremity, and pus was discharged from a sinus in the right foot. Magnetic resonance imaging (MRI) suggested subcutaneous soft tissue infection and osteomyelitis of the right crus. A bacterial culture of pus extracted from a festering sore on the right popliteal fossa detected the growth of Actinomycetes europaeus. The patient was cured with 7 weeks of treatment with intravenous ampicillin-sulbactam, followed by 6 weeks of treatment with oral amoxicillin-clavulanate with surgical debridement and drainage. There were no symptoms of recurrence during the 15-month period of follow-up.. Pediatric actinomycosis is a rare and challenging infectious disease. Early accurate diagnosis and optimal surgical debridement are important for the management of pediatric actinomycosis.

Topics: Actinomyces; Actinomycosis; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Child; Child, Preschool; Drainage; Female; Humans; Magnetic Resonance Imaging; Osteomyelitis

Actinomycosis is an uncommon, chronic suppurative granulomatous infection and needs to be considered as a differential diagnosis. A 56-year-old woman with a background of type 2 diabetes mellitus and breast carcinoma was referred to the Oral and Maxillofacial Surgery 2-week wait clinic, regarding a tender sublingual mass and firm erythematous swelling in the right submandibular and submental region. This was slowly progressive and had not responded to oral co-amoxiclav. An orthopantomogram showed a well-defined radiolucency and smaller radiolucent lesions throughout the edentulous right body of the mandible. A contrast-enhanced CT confirmed a right submandibular abscess communicating with cavitating lesions. The differentials included osteomyelitis, bony metastases, multiple myeloma or other cystic lesions. The patient underwent incision and drainage of the abscess, alongside biopsies, and intravenous co-amoxiclav was given. Microbiology cultures confirmed the presence of

Topics: Abscess; Actinomyces; Actinomycosis, Cervicofacial; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Biopsy; Breast Neoplasms; Diagnosis, Differential; Drainage; Female; Humans; Lymphadenopathy; Mandibular Diseases; Middle Aged; Osteomyelitis; Radiography, Panoramic; Treatment Outcome

Topics: Actinomyces; Actinomycosis; Aged; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Doxycycline; Humans; Male; Mandibular Diseases; Osteomyelitis; Piperacillin, Tazobactam Drug Combination

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Arthritis, Infectious; Cefuroxime; Child; Child, Preschool; Debridement; Denmark; Drainage; Female; Humans; Infant; Infusions, Intravenous; Male; Osteomyelitis; Retrospective Studies; Synovectomy; Therapeutic Irrigation

To assess amoxicillin-clavulanate (AMC) for the oral therapy of diabetic foot infections (DFIs), especially for diabetic foot osteomyelitis (DFO).. We performed a retrospective cohort analysis among 794 DFI episodes, including 339 DFO cases.. The median duration of antibiotic therapy after surgical debridement (including partial amputation) was 30 days (DFO, 30 days). Oral AMC was prescribed for a median of 20 days (interquartile range, 12-30 days). The median ratio of oral AMC among the entire antibiotic treatment was 0.9 (interquartile range, 0.7-1.0). After a median follow-up of 3.3 years, 178 DFIs (22%) overall recurred (DFO, 75; 22%). Overall, oral AMC led to 74% remission compared with 79% with other regimens (χ. Oral AMC is a reasonable option when treating patients with DFIs and DFOs.

Topics: Administration, Oral; Aged; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Diabetic Foot; Female; Humans; Male; Middle Aged; Osteomyelitis; Recurrence; Retrospective Studies; Treatment Outcome

Empiric antibiotic therapy for suspected hematogenous vertebral osteomyelitis (HVO) should be initiated immediately in seriously ill patients and may be required in those with negative microbiological results. The aim of this study was to inform the appropriate selection of empiric antibiotic regimens for the treatment of suspected HVO by analyzing antimicrobial susceptibility of isolated bacteria from microbiologically proven HVO.. We conducted a retrospective chart review of adult patients with microbiologically proven HVO in five tertiary-care hospitals over a 7-year period. The appropriateness of empiric antibiotic regimens was assessed based on the antibiotic susceptibility profiles of isolated bacteria.. In total, 358 cases of microbiologically proven HVO were identified. The main causative pathogens identified were methicillin-susceptible Staphylococcus aureus (33.5%), followed by methicillin-resistant S. aureus (MRSA) (24.9%), Enterobacteriaceae (19.3%), and Streptococcus species (11.7%). Extended spectrum β-lactamase (ESBL)-producing Enterobacteriaceae and anaerobes accounted for only 1.7% and 1.4%, respectively, of the causative pathogens. Overall, 73.5% of isolated pathogens were susceptible to levofloxacin plus rifampicin, 71.2% to levofloxacin plus clindamycin, and 64.5% to amoxicillin-clavulanate plus ciprofloxacin. The susceptibility to these oral combinations was lower in cases of healthcare-associated HVO (52.6%, 49.6%, and 37.6%, respectively) than in cases of community-acquired HVO (85.8%, 84.0%, and 80.4%, respectively). Vancomycin combined with ciprofloxacin, ceftriaxone, ceftazidime, or cefepime was similarly appropriate (susceptibility rates of 93.0%, 94.1%, 95.8%, and 95.8%, respectively).. Based on our susceptibility data, vancomycin combined with a broad-spectrum cephalosporin or fluoroquinolone may be appropriate for empiric treatment of HVO. Fluoroquinolone-based oral combinations may be not appropriate due to frequent resistance to these agents, especially in cases of healthcare-associated HVO.

Topics: Aged; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bacterial Infections; beta-Lactamases; Ciprofloxacin; Clindamycin; Drug Therapy, Combination; Empirical Research; Enterobacteriaceae; Female; Gene Expression; Humans; Levofloxacin; Male; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Middle Aged; Osteomyelitis; Retrospective Studies; Rifampin; Spine; Streptococcus; Vancomycin

Nontuberculous mycobacterial (NTM) disease is commonly an opportunistic infection frequently found in immunocompromised individuals, but sometimes can also be found in the immunocompetent hosts, especially in East Asians. The NTM separation rate in China is increasing, which reminds us to focus on NTM infections in immunocompromised populations.. A 43-year-old woman with a recurrent fever for more than 8-month and a right forehead surgical wounds unhealed for more than 6-month was admitted to our hospital on February 22, 2018. On arrival, several elliptic ulcers were obvious on the right forehead with pus and fibrin exudation, and the skin around the lesions was tender, reddish, no sense of fluctuation. The result of HIV serology test was negative. CD4+ T cell count was normal and tuberculosis antibody was negative. CT of the chest and head showed bone destruction. Skin biopsy on the right forehead was performed on March 13, 2018, and pathological examination of the excisional biopsy specimen found inflammatory granuloma and suppurative inflammatory changes. Broad-spectrum antibiotics were treated but the effect seemed discontent. Then debridement and skin grafting were performed on the right frontal ulcer under general anesthesia on April 3, 2018. The skin tissue culture that resected on March 13, 2018 found Nontuberculous mycobacteria grown after 78 days, so clarithromycin, ethambutol, protionamide, and amoxicillin clavulanate potassium were prescribed for anti-nontuberculous mycobacteria treatment beginning on May 31, 2018. In reviewing the case, Mycobacterium avium (M. avium) was identified in the skin tissue resected on April 3, 2018 by polymerase chain reaction (PCR) and the serum test of anti-interferon-γ autoantibodies was positive.. This is a case report of "Mycobacterium avium SSTI (skin and soft tissue infection) and OM (osteomyelitis) with possible secondary immunodeficiency syndrome induced by anti-interferon-γ autoantibody".

Topics: Adult; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Autoantibodies; Clarithromycin; Ethambutol; Female; Granuloma; Humans; Interferon-gamma; Microbial Sensitivity Tests; Mycobacterium avium; Mycobacterium Infections, Nontuberculous; Osteomyelitis; Scalp; Soft Tissue Infections

Osteomyelitis is not an uncommon emergency department diagnosis in pediatric patients, and most cases are in the lower extremities. Children can present with acute, subacute, or chronic erythema, pain, swelling, or decreased use of the extremity; some patients will also have fever or elevated serum inflammatory markers, or both.. We present the case of a healthy 5-year-old girl who presented to the emergency department with 3 weeks of painless chin swelling and 2 days of erythema and pain. While laboratory testing was normal, magnetic resonance imaging demonstrated osteomyelitis of the mandible, later confirmed by biopsy. After 4 weeks of intravenous antibiotics and an additional 2 weeks of oral antibiotics, the patient recovered completely without any residual findings. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case demonstrates that osteomyelitis can develop in previously healthy, fully vaccinated children with competent immune systems. Systemic findings (ie, fever and elevated serum inflammatory markers) may be absent, and osteomyelitis should always be considered in the differential diagnosis for a child presenting with subacute to chronic cutaneous findings without other clear explanation.

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Biopsy; Child, Preschool; Chin; Emergency Service, Hospital; Female; Humans; Inflammation; Osteomyelitis; Radiography; Ultrasonography

The objective of this study was to retrospectively evaluate and report the associated factors with the diagnosis and management of 24 patients with chronic osteomyelitis of the mandible seen at the authors' institution during the past several years.. Only cases of chronic osteomyelitis of the mandible not associated with antiresorptive medications or radiotherapy to the maxillofacial region were included in the study. After confirmation of the diagnosis, initial clinical and radiologic findings, treatment approach, and outcome were evaluated for each patient. Fourteen male and 10 female patients (average age, 53.75 yr; range, 22 to 83 yr) were included.. The peak incidence of the disease was recorded in the fifth and sixth decades of life. An uneventful healing was observed in 20 patients (83.3%). One of 18 patients (5.5%) who underwent segmental resections developed a secondary infection and was managed with intravenously administered antibiotics. Three of 6 patients (50%) who were treated with marginal resections remained symptomatic after surgery.. Independent of the cause and presentation of the disease, complete resolution of the infection should be the main focus of management in patients with chronic osteomyelitis of the mandible, and findings of this retrospective study indicate that a conservative surgical approach is more likely to result in a less than ideal outcome.

Topics: Administration, Intravenous; Adult; Age Factors; Aged; Aged, 80 and over; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Ampicillin; Anti-Bacterial Agents; beta-Lactams; Chronic Disease; Clindamycin; Doxycycline; Ertapenem; Female; Follow-Up Studies; Fractures, Spontaneous; Humans; Male; Mandibular Diseases; Mandibular Fractures; Middle Aged; Osteomyelitis; Osteosclerosis; Retrospective Studies; Sulbactam; Treatment Outcome; Vancomycin; Young Adult

Acute osteomyelitis of the clavicle accounts for less than 3% of osteomyelitis cases, with its usual location in the middle third. It may be hematogenous, due to contiguity, or secondary to catheterization of the subclavian vein or neck surgery. The diagnosis is often delayed, and clinical symptoms may simulate obstetric brachial plexus palsy in young children. We report a new case of osteomyelitis of the clavicle in a 30-day-old newborn.

Topics: Abscess; Administration, Oral; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Catheterization, Central Venous; Cefotaxime; Clavicle; Female; Fever of Unknown Origin; Follow-Up Studies; Fosfomycin; Fractures, Spontaneous; Haemophilus Infections; Haemophilus influenzae; Humans; Infant; Infant, Newborn; Infectious Disease Transmission, Vertical; Infusions, Intravenous; Male; Osteomyelitis; Pregnancy; Pregnancy Complications, Infectious; Radionuclide Imaging; Sepsis; Streptococcal Infections; Ultrasonography

Osteopetrosis is a heterogeneous disorder characterized by abnormal bone remodeling and increased bone density primarily due to defective osteoclast resorption. The diagnosis is based on a history of numerous fractures and radiological findings indicative of osteosclerosis, usually sufficient for a definitive diagnosis. We present a quite rare case of osteopetrosis complicated by recurrent episodes of maxillomandibular osteomyelitis associated with cutaneous fistulization and purulent nasal discharge. We used intravenous antibiotic therapy and necrotic bone debridement that prevented the appearance of acute infections over a 3-year follow-up, but the complete healing of the case was not achieved.

Topics: Adult; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Combined Modality Therapy; Cutaneous Fistula; Debridement; Female; Follow-Up Studies; Humans; Infusions, Intravenous; Jaw Diseases; Nose Diseases; Osteomyelitis; Osteonecrosis; Osteopetrosis; Osteosclerosis; Recurrence

Topics: Aged; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Fusobacterium Infections; Fusobacterium necrophorum; Humans; Male; Mediastinitis; Osteomyelitis; Sternum

Topics: Abscess; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Child; Female; Humans; Magnetic Resonance Imaging; Metatarsal Bones; Osteomyelitis; Radiography; Tunisia

Appendicitis is a common cause of acute abdominal pain in children and is treated by an open or laparoscopic appendicectomy. Well documented post-operative complications include wound infection, intra-abdominal collection, and adhesional bowel obstruction. We present the rare case of right sacro-iliitis and iliac bone osteomyelitis in a 13 year old boy following an open appendicectomy for a perforated appendicitis.

Topics: Adolescent; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Appendectomy; Appendicitis; Ascitic Fluid; Ciprofloxacin; Clindamycin; Gram-Negative Bacteria; Humans; Laparotomy; Magnetic Resonance Imaging; Male; Metronidazole; Osteomyelitis; Rifampin; Rupture, Spontaneous; Sacroiliitis

Topics: Adenoids; Amoxicillin-Potassium Clavulanate Combination; Ampicillin; Anti-Bacterial Agents; Cellulitis; Child, Preschool; Clindamycin; Cranial Fossa, Posterior; Diagnosis, Differential; Drug Therapy, Combination; Female; Fever; Humans; Lymphadenitis; Magnetic Resonance Imaging; Neck Pain; Occipital Bone; Osteomyelitis; Pharyngitis; Skull Neoplasms; Sulbactam; Tomography, X-Ray Computed

Topics: Adolescent; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Biopsy; Female; Follow-Up Studies; Humans; Mandibular Condyle; Mandibular Diseases; Molar, Third; Osteomyelitis; Osteosclerosis; Surgical Wound Infection; Tomography, X-Ray Computed; Tooth Extraction

Neisseria meningitidis is associated with severe invasive infections such as meningitis and fulminant septicemia. Septic arthritis due to N. meningitidis is rare and bone infections have been reported exceptionally. We report the case of a 7-year-old boy who presented with septic arthritis of the right hip associated with a septic location on the pelvis and pyomyositis of the adjacent muscle. Culture of the joint fluid was sterile but universal 16S polymerase chain reaction (PCR) of this fluid revealed group B N. meningitidis. Our patient had never presented any symptoms of meningitis or septicemia and blood cultures were all sterile. Despite appropriate antibiotic treatment, the course of the disease was unusually long and his status did not improve until surgical lavage of the hip was performed. Moreover, MRI imaging showed bilateral hypersignals of the adjacent muscles and revealed an abscess formation in the left gluteus maximus muscle. Presumptive diagnosis bacterial myositis was confirmed by an elevation of creatine phosphokinase in the sera up to 21-fold the normal value but the culture of the abscess, performed 10 days after initiation of antibiotics, was sterile. Despite an initially unfavorable course, this patient's status improved after surgical drainage and he fully recovered 1 month later. This observation illustrates an unusual presentation of invasive meningococcal infection. The respective roles of infection and an inflammatory phenomenon during the course of the disease are discussed. Moreover, this case emphasizes the value of PCR for bacteriological diagnosis of bone and joint infections.

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Arthritis, Infectious; Child; Creatine Kinase; Drainage; Hip Joint; Humans; Male; Meningococcal Infections; Neisseria meningitidis, Serogroup B; Osteomyelitis; Pyomyositis; Therapeutic Irrigation

Apart from neoplastic processes, chronic disfiguring and destructive diseases of the mandible are uncommon.. We report, perhaps for the first time, the simultaneous occurrence of two such conditions in one patient, in a case that emphasizes the importance of bone biopsy in establishing the correct diagnosis. Florid cemento-osseous dysplasia (FCOD) is a chronic, disfiguring condition of the maxillofacial region. This relatively benign disease is primarily observed in middle-aged women of African ancestry. Cervicofacial actinomycosis is an uncommon and progressive infection caused by bacilli of the Actinomyces genus that typically involves intraoral soft tissues but may also involve bone. The accurate diagnosis of actinomycosis is critical for successful treatment. A diagnosis of osteomyelitis caused by Actinomyces bacteria was diagnosed by bone biopsy in a 53 year-old African-American woman with a longstanding history of FCOD after she presented with a new draining ulcer overlying the mandible.. Clinicians should be aware of the possibility of actinomycosis arising in the setting of FCOD, and the importance of bone biopsy and cultures in arriving at a definitive and timely diagnosis.

Topics: Actinomycosis, Cervicofacial; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; beta-Lactams; Denture, Complete, Lower; Drug Combinations; Ertapenem; Female; Fibrous Dysplasia of Bone; Humans; Mandibular Diseases; Middle Aged; Oral Ulcer; Osteomyelitis; Radiography

Topics: Adult; Amoxicillin-Potassium Clavulanate Combination; Ampicillin; Anti-Bacterial Agents; Brain Abscess; Frontal Bone; Frontal Sinusitis; Humans; Magnetic Resonance Imaging; Male; Osteomyelitis; Sulbactam

A case of a subcutaneous abscess caused by Clostridium perfringens infection in a five-month-old dog is reported in this study. Clinical examination, radiological findings and cytological analysis of abscess fluid were consistent with Clostridium induced disease. Treatment including drainage of the abscess and antibiotic therapy led to rapid clinical improvement. However, despite aggressive medical therapy and proper wound care, the deep soft tissue infection led to osteomyelitis with premature closure of the growth plates of the tibia and secondary bone shortening. Prolonged treatment with metronidazole and amoxicillin-clavulanic acid resulted in an excellent outcome with normal weight bearing.

Topics: Abscess; Amoxicillin-Potassium Clavulanate Combination; Animals; Anti-Bacterial Agents; Clostridium Infections; Clostridium perfringens; Dog Diseases; Dogs; Drainage; Hindlimb; Male; Metronidazole; Osteomyelitis; Treatment Outcome; Wound Infection

Foot problems are common causes of morbidity in patients with diabetes mellitus. Foot ulcers are the leading cause of hospitalization in diabetic patients. Bones may be involved in two different clinical conditions: osteomyelitis and Charcot osteoarthropathy. Osteomyelitis usually develops by spreading from contiguous soft tissue to underlying bone. Charcot foot is deformation of foot as a result of muscle athrophy, bone and joint structure changes in a joint as a secondary complication of neuropathy. To distinguish bone infection from non-infectious bone disorders as in Charcot joint may be difficult, especially if there is no skin ulceration. So, the mere absence of skin ulcers does not exclude the diagnosis of osteomyelitis.

Topics: Aged; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Arthropathy, Neurogenic; Blood Sedimentation; Diabetic Foot; Diagnosis, Differential; Forefoot, Human; Humans; Magnetic Resonance Imaging; Male; Osteomyelitis; Radiography

We describe the first clinical isolate of Bordetella petrii from a patient with mandibular osteomyelitis. The only previously documented isolation of B. petrii occurred after the initial culture of a single strain from an environmental source.

Topics: Aged; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bordetella; Bordetella Infections; Drug Resistance, Multiple, Bacterial; Humans; Male; Osteomyelitis

Topics: Amoxicillin-Potassium Clavulanate Combination; Anesthesia, Epidural; Child; Drug Therapy, Combination; Humans; Magnetic Resonance Imaging; Male; Osteomyelitis; Pain

For 12 years, a 26-year-old man had acne conglobata and a non-suppurative diffuse sclerosing osteomyelitis of the mandible as part of a chronic recurrent multifocal osteomyelitis of the sternum, the pelvic bones, and the femoral head, and aseptic arthritis of the knee, the fibulotalar, and the sternoclavicular joints. This fulfills the formal criteria of the SAPHO syndrome. Repeated surgical and antibiotic treatment combined with hyperbaric oxygen caused partial improvement. Complete relief and partial disappearance of the scintigraphic lesions was achieved with long-term corticosteroids, non-steroidal anti-inflammatory drugs, minocycline, and isotretinoin.

Topics: Acne Vulgaris; Acquired Hyperostosis Syndrome; Adult; Amoxicillin-Potassium Clavulanate Combination; Anti-Inflammatory Agents; Dermatologic Agents; Drug Therapy, Combination; Humans; Isotretinoin; Male; Mandibular Diseases; Osteomyelitis; Prednisolone; Radionuclide Imaging

Forty one children and adolescents (mean age 11.9 years) with chronic osteomyelitis that were not previously managed surgically were prospectively studied during a 5-year period in the University of Calabar Teaching Hospital, Calabar, Nigeria. All cases were managed by sequestrectcomy of curretage and local muscle flap implantation into the space so created. Preoperative care in this series included blood transfusion for anaemic patients and augmentin (amoxycillin and clavulanic acid) while definitive antibiotic therapy depended on the antimicrobial sensitivity pattern of Staphylococcus aureus and Pseudomonas species which were the predominant bacterial isolates. Overall, the incidence of wound dehiscence and recurrence of chronic osteomyelitis were low (19.5%), and complete healing of all cases occurred by two years of follow-up. The major complications were joint stiffness, limb shortening and pathological fractures.

Topics: Adolescent; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Antibiotic Prophylaxis; Child; Child, Preschool; Chronic Disease; Clavulanic Acids; Debridement; Drug Therapy, Combination; Female; Humans; Male; Osteomyelitis; Prospective Studies; Radiography; Surgical Flaps; Treatment Outcome

A rat model of Staphylococcus aureus osteomyelitis was used to compare treatment with co-amoxiclav, flucloxacillin and clindamycin. Co-amoxiclav (amoxycillin/clavulanic acid 200/50 mg/kg), flucloxacillin (200 mg/kg) and clindamycin (50 mg/kg) were injected subcutaneously tds for 28 days, commencing 14 days after infection. Eight days after cessation of treatment, high numbers of staphylococci were recovered from the infected tibiae of all control rats. All treatments, at clinically achievable concentrations, significantly (P < 0.05) reduced the bone bacterial titres. However, 50% of tibiae from co-amoxiclav-treated animals were sterile, compared with 17% and 25% from flucloxacillin- or clindamycin-treated animals respectively. Histopathological examination of tibiae reflected the bacteriological results, and showed that the severity of the osteomyelitis was greatly reduced in antibiotic-treated animals compared with non-treated controls. Twenty-eight days after cessation of therapy, bacterial counts from co-amoxiclav and clindamycin-treated animals remained significantly (P < 0.05) lower than those of non-treated controls, although the gross and microscopic appearance of clindamycin and flucloxacillin-treated tibiae suggested that recrudescence of the infection may have occurred. The results of this study demonstrated that co-amoxiclav was as effective as flucloxacillin and clindamycin in the treatment of an experimental chronic staphylococcal osteomyelitis.

Topics: Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Animals; Clavulanic Acids; Clindamycin; Disease Models, Animal; Drug Therapy, Combination; Floxacillin; Male; Osteomyelitis; Rats; Staphylococcal Infections; Staphylococcus aureus; Tibia

Topics: Adult; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Bacteroides Infections; Clavulanic Acids; Drug Therapy, Combination; Eikenella corrodens; Humans; Male; Osteomyelitis; Radiography; Spinal Diseases