trimethoprim--sulfamethoxazole-drug-combination and Osteomyelitis

The management of some serious infections such as infective endocarditis (IE) and bone and joint infections (BJIs) caused by Gram-positive cocci (GPC) is complex and requires great responsiveness and effective antimicrobials with high bioavailability in heart valves or bone tissues. Treatment of these infections requires the use of a higher dosage that may result in increased toxicity or the use of new promising antimicrobials to control the infection. However, use of these new antimicrobials could still bring about new toxicity and resistance. Another approach may be the 'comeback' of old antimicrobials, which is evaluated in this review in the treatment of IE and BJIs caused by GPC.

Topics: Anti-Bacterial Agents; Bone and Bones; Communicable Diseases; Endocarditis, Bacterial; Gram-Positive Bacterial Infections; Gram-Positive Cocci; Humans; Joints; Osteomyelitis; Prosthesis-Related Infections; Trimethoprim, Sulfamethoxazole Drug Combination

A 51 year old woman without significant past medical history or risk factors for Nocardia infection developed primary Nocardia nova sternal osteomyelitis with mediastinal abscess, diagnosed with open biopsy. She required prolonged antibiotic therapy and had a favorable outcome. Primary sternal osteomyelitis develops in the absence of a contiguous focus of infection, as opposed to secondary sternal osteomyelitis, which is usually a complication of sternotomy. Staphylococcus aureus probably still is the most common cause of both forms of sternal osteomyelitis. Nocardia species invade humans usually through the respiratory tract and can cause a variety of localized infections through the hematogenous route. Pulmonary involvement may or may not coexist. Immunosuppressed patients are more prone to infection by Nocardia species, although cases involving seemingly immunocompetent patients are not rare. This is the first reported case in the English literature of primary sternal osteomyelitis due to Nocardia nova or any other Nocardia species.

Topics: Female; Humans; Middle Aged; Nocardia Infections; Osteomyelitis; Sternum; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Anti-Bacterial Agents; Clindamycin; Humans; Methicillin Resistance; Osteomyelitis; Staphylococcal Infections; Staphylococcus aureus; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination; Vancomycin

Chronic osteomyelitis has been a difficult problem for patients and the treating physicians. Appropriate antibiotic therapy is necessary to arrest osteomyelitis along with adequate surgical therapy. Factors involved in choosing the appropriate antibiotic(s) include infection type, infecting organism, sensitivity results, host factors, and antibiotic characteristics. Initially, antibiotics are chosen on the basis of the organisms that are suspected to be causing the infection. Once the infecting organism(s) is isolated and sensitivities are established, the initial antibiotic(s) may be modified. In selecting specific antibiotics for the treatment of osteomyelitis, the type of infection, current hospital sensitivity resistance patterns, and the risk of adverse reactions must be strongly appraised. Antibiotic classes used in the treatment of osteomyelitis include penicillins, beta-lactamase inhibitors, cephalosporins, other beta-lactams (aztreonam and imipenem), vancomycin, clindamycin, rifampin, aminoglycosides, fluoroquinolones, trimethoprim-sulfamethoxazole, metronidazole, and new investigational agents including teicoplanin, quinupristin/dalfopristin, and oxazolidinones. Traditional treatments have used operative procedures followed by 4 to 6 weeks of parenteral antibiotics. Adjunctive therapy for treating chronic osteomyelitis may be achieved by using beads, spacers, or coated implants to deliver local antibiotic therapy and/or by using hyperbaric oxygen therapy (once per day for 90-120 minutes at two to three atmospheres at 100% oxygen).

Topics: Anti-Infective Agents; beta-Lactamase Inhibitors; Cephalosporins; Chronic Disease; Drug Resistance, Microbial; Humans; Hyperbaric Oxygenation; Microbial Sensitivity Tests; Osteomyelitis; Penicillins; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Administration, Oral; Anti-Bacterial Agents; Anti-Infective Agents; Chronic Disease; Drug Therapy, Combination; Fluoroquinolones; Gram-Negative Bacterial Infections; Humans; Osteomyelitis; Rifampin; Staphylococcal Infections; Trimethoprim, Sulfamethoxazole Drug Combination

A 22-year-old man had Salmonella panama osteomyelitis of the left distal tibia. He had endured a period of untreated diarrhea without fever 6 years before. The osteomyelitis was treated successfully with surgical debridement followed by 9 weeks of oral cotrimoxazole 960 mg twice daily. Salmonella osteomyelitis is rare. Most cases occur in patients with sickle cell anemia. Other conditions of local or generalized immunosuppression are also risk factors, but none were established in this patient, nor was he a chronic carrier. In reviewing the literature, no case of Salmonella panama osteomyelitis in an otherwise healthy patient was found. Although the osteomyelitis in this patient was possibly secondary to Salmonella enteritis 6 years before, the authors believe that enteric Salmonella infections should not be treated with antibiotics unless the infection is accompanied by systemic symptoms. Otherwise, the risk of chronic carriership is substantially increased. In case of Salmonella panama osteomyelitis, surgical debridement is recommended as the main component of treatment, followed by a prolonged period of specific antibiotic therapy.

Topics: Adult; Anti-Bacterial Agents; Combined Modality Therapy; Debridement; Humans; Male; Osteomyelitis; Radiography; Salmonella; Salmonella Infections; Tibia; Trimethoprim, Sulfamethoxazole Drug Combination

Oral therapies alternative to fluoroquinolones against staphylococcal chronic osteomyelitis have not been evaluated in comparative studies. Consecutive nonaxial Staphylococcus aureus chronic osteomyelitis cases were included in a comparative trial after debridement. Fifty patients were randomized: group A (n = 22) was treated with cloxacillin for 6 weeks intravenously plus 2 weeks orally (p.o.), and group B (n = 28) was treated with rifampin-cotrimoxazole for 8 weeks p.o. During follow-up (10 years), five relapses occurred: two (10%) in group A and three (11%) in group B. Foreign-body maintenance was associated with relapse (P = 0.016). Oral rifampin-cotrimoxazole treatment showed outcomes comparable to those for intravenous cloxacillin treatment.

Topics: Administration, Oral; Adult; Aged; Anti-Infective Agents; Cloxacillin; Drug Combinations; Female; Follow-Up Studies; Humans; Injections, Intravenous; Male; Middle Aged; Osteomyelitis; Rifampin; Staphylococcal Infections; Trimethoprim, Sulfamethoxazole Drug Combination

Both linezolid and cotrimoxazole are antibiotics that are well suited for oral therapy of bone and joint infections (BJI) caused by otherwise resistant Gram-positive cocci (GPC) (resistance to fluoroquinolones, maccolides, betalactamines). However, in this context, no data are currently available regarding the safety and tolerance of these antibiotics in combination with rifampicin. The objective of this study was to compare the efficacy and safety of a combination of rifampicin and linezolid (RLC) with those of a combination of rifampicin and cotrimoxazole (RCC) in the treatment of BJI. Between February 2002 and December 2006, 56 adult patients (RLC, n = 28; RCC, n = 28), including 36 with infected orthopaedic devices (RLC, n = 18; RCC, n = 18) and 20 with chronic osteomyelitis (RLC, n = 10; RCC, n = 10), were found to be eligible for inclusion in this study. Patients who discontinued antibiotic therapy within 4 weeks of commencing treatment were considered to represent cases of treatment failure and were excluded. Rates of occurrence of adverse effects were similar in the two groups, at 42.9% in the RLC group and 46.4% in the RCC group (p = 1.00), and led to treatment discontinuation in four (14.3%) RLC and six (21.4%) RCC patients. Cure rates were found to be similar in the two groups (RLC, 89.3%, RCC, 78.6%; p = 0.47). Prolonged oral RLC and RCC therapy were found to be equally effective in treating patients with BJI caused by resistant GPC, including patients with infected orthopaedic devices. However, the lower cost of cotrimoxazole compared with linezolid renders RCC an attractive treatment alternative to RLC. Further larger clinical studies are warranted to confirm these preliminary results.

Topics: Acetamides; Administration, Oral; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Chronic Disease; Drug Therapy, Combination; Female; Gram-Positive Bacterial Infections; Gram-Positive Cocci; Humans; Linezolid; Male; Middle Aged; Orthotic Devices; Osteomyelitis; Oxazolidinones; Prosthesis-Related Infections; Rifampin; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Young Adult

We describe a rare case of a disseminated. A 91-year-old female patient was admitted with oedema of her right leg, fever of 38 °C and data consistent with ruptured Baker's cyst. A disseminated. The implementation of a combination of intravenous antibiotics and drainages resulted in an initial improvement in the patient's condition. However, despite these interventions, the patient ultimately passed away probably due to natural causes.

Topics: Aged; Aged, 80 and over; Bacteremia; Female; Humans; Nocardia Infections; Osteomyelitis; Pubic Bone; Trimethoprim, Sulfamethoxazole Drug Combination

Nocardia infection is an uncommon and rare condition in immunocompetent patient. A case of cutaneous nocardiosis complicated with osteomyelitis of the vault scalp in a 64-year-old man, with no remarkable past medical history, is reported. Treatment with trimethoprime-sulfamethoxazole than doxycycline for 12 months led to complete resolution and no evidence of recurrence was noted. Nocardia infection should be considered even in immunocomptent patients and doxycycline is a good alternative for treatment.

Topics: Anti-Bacterial Agents; Doxycycline; Humans; Male; Middle Aged; Nocardia Infections; Osteomyelitis; Skull; Trimethoprim, Sulfamethoxazole Drug Combination

Although the frequency of bone and joint infections caused by Enterobacter spp. is increasing, studies regarding the optimal antibiotic therapy are scarce. The objective of this retrospective study was to assess the clinical outcomes and safety of a fluoroquinolone-cotrimoxazole combination for the treatment of bone and joint infections caused by Enterobacter cloacae. Between 2010 and 2017, 30 patients with bone and joint infections caused by E. cloacae were treated with a fluoroquinolone-cotrimoxazole combination for 8-12 weeks. There were 26 cases (87%) of infection of an internal fixation device, two cases (6.6%) of pseudarthrosis with chronic osteomyelitis, and two cases (6.6%) of infection of knee and ankle prosthetic devices. The cure rate of the fluoroquinolone-cotrimoxazole combination was 80% by intention-to-treat analysis, with a mean follow-up of 29.3 ± 19.1 months. The fluoroquinolone-cotrimoxazole combination for 8-12 weeks is effective for the treatment of bone and joint infections caused by E. cloacae.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Arthritis; Drug Therapy, Combination; Drug-Related Side Effects and Adverse Reactions; Enterobacter cloacae; Enterobacteriaceae Infections; Female; Fluoroquinolones; Humans; Male; Middle Aged; Osteomyelitis; Prosthesis-Related Infections; Retrospective Studies; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Young Adult

Nocardiosis is a rare infection caused by the aerobic actinomycete of the Nocardia genus. In most cases, nocardiosis manifests as a lung infection or a bone lesion. Due to the nonspecific and mild clinical manifestations of nocardiosis, the establishment of definite diagnosis can be difficult. When antibiotic therapy is incorrectly targeted, only the symptoms of the disease are suppressed. The mainstay in the treatment of Nocardia osteomyelitis has so far been the combined surgical debridement with long-term, initially intravenous, antibiotic administration. We present the successful conservative treatment of a nocardiosis osteomyelitis of the tibia caused by the Nocardia cyriacigeorgica species in an 81-year-old female patient that manifested itself as a secondary affection on top of a primary nocardiosis infection of the lung. From microbiological examination, N. cyriacigeorgica was discovered; the identification was made using matrix-assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF MS) with an identification score of 1.9. The sensitivity was evaluated using E test. Sensitivity to trimethoprim/sulfamethoxazole, amikacin, imipenem, and linezolid was demonstrated. The bacteria were shown to be resistant to ciprofloxacin. For treatment, trimethoprim/sulfamethoxazole was used due to the value of minimum inhibitory concentration, which was 0.25 mg/L. The initial dose of 960 mg of trimethoprim/sulfamethoxazole every 8 h was reduced to 960 mg every 12 h after 3 months. The total duration of treatment was 7.5 months. Under the established treatment, the bone and lung lesions healed. Nocardiosis of the long bone is considered a rare disease and its precise diagnosis has not yet been standardized. We used the MALDI-TOF MS method for the identification of the causal organism which is a fast and reliable method according to current world literature even when compared with the rRNA genetic sequencing reference method. Our case study presents a rare case of osteomyelitis of tibial shaft caused by N. cyriacigeorgica and its successful conservative treatment.

Topics: Aged, 80 and over; Anti-Bacterial Agents; Female; Humans; Microbial Sensitivity Tests; Nocardia; Nocardia Infections; Osteomyelitis; Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Aged, 80 and over; Anti-Bacterial Agents; Bacteremia; Burkholderia cepacia; Burkholderia Infections; Drug Resistance, Multiple, Bacterial; Drug Therapy, Combination; Female; Humans; Osteomyelitis; Recurrence; Salvage Therapy; Tigecycline; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Anti-Bacterial Agents; Burkholderia pseudomallei; Ceftazidime; Doxycycline; Female; Femur; Humans; Levofloxacin; Magnetic Resonance Imaging; Melioidosis; Osteomyelitis; Positron Emission Tomography Computed Tomography; Travel; Trimethoprim, Sulfamethoxazole Drug Combination

We report the case of a 35-year-old male, who was diagnosed with systemic lupus erythematosus (SLE) in 2010 based on the presence of articular, serous, renal, immune, and hematologic involvement. He also had secondary antiphospholipid syndrome (APS). He was treated with prednisone 10 mg per day, hydroxychloroquine 200 mg per day, methotrexate 12.5 mg per week, leflunomide 20 mg per day, and oral anticoagulation previous to the present event. He presented to emergency room with a 7 day disease duration characterized by pain in the left thigh, which increased with physical activity, resulting in claudication; he also had malaise and fever. The X-ray films showed periostitis of the lower half of the left femur with bone marrow narrowing; the scintigraphy showed marked increased uptake in the middle and distal thirds of the left femur, and magnetic resonance imaging (MRI) showed thickening and hyperintensity of the cortex of the diaphysis and distal epiphysis of the femur and endosteal irregularity. Empirical treatment was started with vancomycin for 3 weeks. Femur biopsy and cultures were performed, isolating Salmonella spp. group "D" Vi (-); treatment with cotrimoxazole and ceftazidime for 4 weeks followed by doxycycline and cotrimoxazole for 4 months were given with a favorable functional outcome. This is an unusual case of a young adult with Garre's sclerosing osteomyelitis associated to SLE and caused by salmonella. The literature is reviewed and the clinical conditions predisposing to this infection are discussed, particularly in patients with SLE.

Topics: Adult; Anti-Bacterial Agents; Antiphospholipid Syndrome; Ceftazidime; Doxycycline; Femur; Humans; Hydroxychloroquine; Immunosuppressive Agents; Isoxazoles; Leflunomide; Lupus Erythematosus, Systemic; Male; Methotrexate; Osteomyelitis; Prednisone; Salmonella Infections; Sclerosis; Trimethoprim, Sulfamethoxazole Drug Combination

Kingella species including K. kingae are non-motile coccobacilli or short straight rods, and their normal habitats appear to be the upper respiratory and oropharyngeal tracts of humans. In recent years, K. kingae strains have been increasingly recognized as common causes of invasive infections in children at the age of less than 4 years. In Japan, however, invasive K. kingae infections including osteomyelitis have rarely been described. We incidentally encountered isolation of a K. kingae strain from intraoperatively obtained specimens from a previously healthy 44-month-old boy. He first consulted a nearby medical facility and a suspected diagnosis of osteomyelitis was made, after which the patient was then transferred to our Nagano Children's hospital. There was evidence of inflammation in his right calcaneus and toe walking was noted. He was treated with surgical drainage. An isolate grown on sheep blood agar with positive oxidase and negative catalase was biochemically characterized with the ID-Test HN20 (Nissui Pharmaceutical Co., Ltd., Tokyo, Japan) kit system together with genetic examinations involving sequencing the 16S rRNA gene, and the infection was finally identified as K. kingae. The patient was successfully treated with cefotiam (CTM) for the first 7 days followed by the administration of trimethoprim-sulfamethoxazole (ST) for an additional 2 months. The K. kingae isolate was confirmed as a sure causative pathogen by observing that the serum showed high agglutinin titers against the isolate. Accumulation of the case reports in Japan with the isolation of this species is essential for clarifying invasive infections due to K. kingae. Our case report is a noteworthy and useful piece of information.

Topics: Ankle; Arthritis, Infectious; Cefotiam; Child, Preschool; Humans; Japan; Kingella kingae; Male; Osteomyelitis; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Anti-Bacterial Agents; Child; Humans; Osteomyelitis; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

We report two cases of daptomycin (DAP)-nonsusceptible (DNS) vancomycin-intermediate Staphylococcus aureus (VISA) vertebral osteomyelitis cases complicated by bacteremia treated with high-dose daptomycin and trimethoprim-sulfamethoxazole. Both patients responded rapidly and favorably to this combination. The clinical isolates from the two patients were tested post hoc in an in vitro pharmacokinetic/pharmacodynamic (PK/PD) model to confirm the bactericidal activity and enhancement of daptomycin and trimethoprim-sulfamethoxazole. The combination of high-dose daptomycin and trimethoprim-sulfamethoxazole should be explored further for the treatment of DNS VISA strains.

Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacteremia; Daptomycin; Drug Therapy, Combination; Female; Humans; Male; Microbial Sensitivity Tests; Osteomyelitis; Spine; Staphylococcal Infections; Staphylococcus aureus; Trimethoprim, Sulfamethoxazole Drug Combination; Vancomycin

Edwardsiella tarda, a catalase-positive bacillus widely distributed throughout nature, is generally susceptible to trimethoprim/sulfamethoxazole. We describe osteomyelitis due to trimethoprim/sulfamethoxazole-resistant E. tarda in a patient with chronic granulomatous disease (CGD). Once E. tarda acquires antibiotic resistance, infected CGD patients may develop severe infections with unforeseeable consequences.

Topics: Adolescent; Anti-Bacterial Agents; Drug Resistance, Bacterial; Edwardsiella tarda; Enterobacteriaceae Infections; Granulomatous Disease, Chronic; Humans; Infant, Newborn; Leg; Magnetic Resonance Imaging; Male; Osteomyelitis; Radiography; Trimethoprim, Sulfamethoxazole Drug Combination

The emergence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) has complicated the conventional management of osteomyelitis. While oral clindamycin is commonly used to treat acute CA-MRSA osteomyelitis, the emergence of inducible clindamycin resistance among CA-MRSA isolates has made alternative therapy necessary. The excellent oral bioavailability, susceptibility profile, favorable palatability, and low cost of trimethoprim-sulfamethoxazole (TMP-SMX) make this drug an attractive option for treating osteomyelitis, yet its clinical efficacy for osteomyelitis has not been established.. Between October 1998 and September 2009, 20 children who received a TMP-SMX-containing regimen for acute osteomyelitis at All Children's Hospital were identified from hospital records, and their cases reviewed for clinical outcome and drug safety.. Patients ranged in age from 9 months to 17 years. Twelve (60%) of the patients were male. Causative pathogens were found in 8 (40%) cases of which 5 were CA-MRSA and 3 were methicillin-susceptible Staphylococcus aureus. Eleven patients (55%) received TMP-SMX as their primary therapy. The median dose of TMP-SMX was 16.4 mg/kg/d. During TMP-SMX therapy, 8 patients (40%) experienced adverse events; all were considered mild. Duration of total therapy was 26 to 59 days, with a median of 40 days. All 20 patients were considered cured of their infection at the end of therapy.. Orally administered TMP-SMX appears to be a useful and well-tolerated therapy for treatment of acute osteomyelitis in children. Further prospective comparative studies will be needed to confirm this observation.

Topics: Acute Disease; Administration, Oral; Adolescent; Anti-Infective Agents; Child; Child, Preschool; Female; Hospitals, Pediatric; Humans; Infant; Male; Methicillin-Resistant Staphylococcus aureus; Osteomyelitis; Retrospective Studies; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Ampicillin; Anti-Bacterial Agents; Back Pain; Bacteremia; Diagnosis, Differential; Discitis; Haemophilus; Haemophilus Infections; Humans; Intervertebral Disc; Liver Cirrhosis; Magnetic Resonance Imaging; Male; Middle Aged; Osteomyelitis; Trimethoprim, Sulfamethoxazole Drug Combination

The ancient method of larval therapy for treatment of acute and chronic infections has become a revival and a new dimension with introduction of the Biobag (Vitapad). With use of this therapy trauma patients suffering infectious complications can be treated very effective, which can reduce the overall time needed for treatment and can result in diminished invalidity.

Topics: Animals; Athletic Injuries; Bone Plates; Debridement; Device Removal; Enterobacter cloacae; Enterobacteriaceae Infections; Floxacillin; Fracture Fixation, Internal; Humans; Larva; Male; Middle Aged; Osteomyelitis; Staphylococcal Infections; Surgical Wound Infection; Tibial Fractures; Trimethoprim, Sulfamethoxazole Drug Combination; Wound Healing

Topics: Aged; Anti-Infective Agents; Female; Gram-Negative Bacterial Infections; Humans; Osteomyelitis; Stenotrophomonas maltophilia; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Anti-Infective Agents; Antitubercular Agents; Child, Preschool; Female; Humans; Hypergammaglobulinemia; Immunoglobulin M; Osteomyelitis; Radiography; Syndrome; Trimethoprim, Sulfamethoxazole Drug Combination; Tuberculosis, Cutaneous; Tuberculosis, Osteoarticular; Ulna

Topics: Adolescent; Cefotaxime; Humans; Knee; Male; Osteomyelitis; Radiography; Salmonella enteritidis; Salmonella Infections; Trimethoprim, Sulfamethoxazole Drug Combination

Human infection with Nocardia species presents as a wide range of clinical syndromes. Nocardia is an important opportunistic pathogen in immunocom-promised patients. We report a case of primary Nocardia asteroides osteomyelitis as the initial clinical presentation of AIDS. The infection was successfully treated with a prolonged course of trimethoprim-sulfamethoxazole in conjunction with HAART. Nocardia osteomyelitis should be recognized as an unusual but important and treatable opportunistic infection in patients living with HIV infection.

Topics: Adult; AIDS-Related Opportunistic Infections; Amikacin; Antiretroviral Therapy, Highly Active; Humans; Magnetic Resonance Imaging; Male; Nocardia Infections; Osteomyelitis; Trimethoprim, Sulfamethoxazole Drug Combination

It is occasionally difficult to distinguish the features of spinal brucellosis from those of ankylosing spondylitis (AS), and the resultant delayed diagnosis may allow insidious progression of the complications of the brucella infection. The case of a 33-year-old male HLA-B27-positive patient with known diagnosis of AS for 7 years, who developed a paravertebral abscess in the left erector spinae muscle due to brucellosis, is presented in this paper. This case report illustrates two important points; first, co-occurrence of AS and brucellosis in the same patient, and second, posterior element involvement with abscess formation in erector spinae muscle, which has not been previously reported. Magnetic resonance imaging is a sensitive method for detecting spinal brucellosis and extent of infection throughout paravertebral structures. Clinicians serving patients from areas with endemic brucellosis should not overlook the possibility of this infection in the presence of axial musculoskeletal symptoms, even among patients with AS.

Topics: Abscess; Adult; Anti-Bacterial Agents; Brucella; Brucellosis; Diclofenac; Doxycycline; Drug Therapy, Combination; Humans; Lumbosacral Region; Magnetic Resonance Imaging; Male; Muscle, Skeletal; Myositis; Osteomyelitis; Spondylitis, Ankylosing; Streptomycin; Sulfasalazine; Trimethoprim, Sulfamethoxazole Drug Combination

Oral antibiotic therapy achieves clinical and bacteriological cure of the adult bacterial osteomyelitis associated or not to orthopedic implant.. We carried out a prospective study, with follow-up at 24 months, of patients with adult bacterial osteomyelitis, that were initially treated with parenteral antibiotic therapy for a week, followed with oral antibiotic therapy during 2 to 6 months, depending on the absence or presence or orthopedic implant, respectively.. 37 patients presented 44 episodes of adult bacterial osteomyelitis, 34 of them in presence of orthopedic implant. The most frequent causative microorganism was S. aureus (44%), followed by coagulase-negative Staphylococcus (29%). The oral antibiotic therapy most frequently employed was the combination cotrimoxazole-rifampin, followed by ciprofloxacin-rifampin. The clinical and bacteriologic cure were 85%, 82% in the group with orthopedic implant. 82% required surgical intervention.. The oral antibiotic therapy, preceded by a short parenteral therapy, can get high rates of clinical and bacteriological cure in the adult's bacterial osteomyelitis.

Topics: Administration, Oral; Adolescent; Adult; Aged; Aged, 80 and over; Anti-Infective Agents; Antibiotics, Antitubercular; Bacterial Infections; Ciprofloxacin; Combined Modality Therapy; Drug Combinations; Female; Follow-Up Studies; Humans; Male; Middle Aged; Osteomyelitis; Prospective Studies; Rifampin; Time Factors; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

To evaluate the efficacy and safety of cotrimoxazol plus rifampicin in staphylococcal osteoarticular infection.. Open, non-comparative study of adult hospitalized patients with documented staphylococcal bone infection.. From Feb 1989 to Dec 1993 28 episodes of staphylococcal bone infection were treated in 14 men and 13 women; the mean age was 48 +/- 21 years (range, 11-84). They received cotrimoxazol (7 mg/kg/day of trimethoprim) plus rifampicin (600-1200 mg/day), both orally, every 8 to 12 h with a mean duration of treatment of 34.2 +/- 8.2 days (range, 21 to 55 days). This antibiotic regimen was initiated at the same time that appropriate surgery for each specific condition was undertaken. Diagnoses were postsurgical osteomyelitis (10 cases), infected total hip prostheses (4 cases, one with 2 episodes), osteomyelitis secondary to external pin fixation (5 cases), soft tissue infections linked to orthopedic implants (3 cases), two cases of metatarsal osteomyelitis (one diabetic foot and one patient with polineuropathy), and one case each of chronic osteomyelitis of femur, hematogenous lumbar spondylitis and posttraumatic osteomyelitis. Four patients had bacteremia. The duration of the infection, prior to surgery was less than one month in 12 episodes, 1 month to 2 years in 14, and in 2 cases, of 10 and 13 years, respectively. In 23 episodes the causal agent was Staphylococcus aureus and in 5 cases it was coagulase-negative staphylococci. Patients had received previous parenteral therapy with other antimicrobials during 2-40 days (X: 18.6 +/- 10.2 days). All patients but one had resolution of the infection and are currently asymptomatic 6 months to 5 years posttreatment in the 21 evaluable cases (X: 38 +/- 13.1 months). Five patients had adverse effects secondary to the antibiotic combination and in three these were severe enough to discontinue the antimicrobials. In no case of the 11 patients with post-treatment control cultures were staphylococci recovered from the wound.. The combination of cotrimoxazole plus rifampicin, both given orally, was highly effective in this selected group of patients. This combination should be considered as a useful alternative therapy of staphylococcal bone infection and deserves further study.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacteremia; Child; Drug Therapy, Combination; Female; Humans; Lumbar Vertebrae; Male; Middle Aged; Osteomyelitis; Postoperative Complications; Retrospective Studies; Rifampin; Spondylitis; Staphylococcal Infections; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Animals; Anti-Bacterial Agents; Cats; Humans; Male; Osteomyelitis; Pasteurella Infections; Pasteurella multocida; Toes; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Anti-Bacterial Agents; Antibiotics, Antitubercular; Arthrodesis; beta-Lactam Resistance; Hip Prosthesis; Humans; Joint Prosthesis; Knee Prosthesis; Osteomyelitis; Prognosis; Prospective Studies; Prosthesis-Related Infections; Reoperation; Rifampin; Risk Factors; Staphylococcal Infections; Staphylococcus aureus; Staphylococcus epidermidis; Teicoplanin; Tomography, X-Ray Computed; Trimethoprim, Sulfamethoxazole Drug Combination; Vancomycin

We report the successful treatment of disseminated Mycobacterium intracellulare osteomyelitis, without evidence of other visceral involvement, in a previously healthy, HIV-negative, 2-year-old female using a 23-month regimen of antimicrobial agents that included 18 months of oral therapy with azithromycin, rifabutin, trimethoprim-sulfamethoxazole (TMP/SMX), and ethambutol.

Topics: Azithromycin; Child, Preschool; Drug Therapy, Combination; Ethambutol; Female; Follow-Up Studies; HIV Seronegativity; Humans; Immunocompetence; Mycobacterium avium Complex; Mycobacterium avium-intracellulare Infection; Osteolysis; Osteomyelitis; Rifabutin; Trimethoprim, Sulfamethoxazole Drug Combination

Salmonella infections in man can be divided in five clinical groups: enteric fever, septicaemia without localization, focal disease, gastroenteritis and the carrier state. Salmonella typhi is mostly associated with enteric fever and the carrier state. Bone infections due to S. typhi have been reported relatively seldom. They usually occur as the result of metastatic spread during septicaemia or, more rarely, after direct inoculation. Two patients with S. typhi osteomyelitis of the forearm without evidence of a primary infection or direct inoculation are presented here.

Topics: Adult; Cefotaxime; Forearm; Humans; Male; Ofloxacin; Osteomyelitis; Trimethoprim, Sulfamethoxazole Drug Combination; Typhoid Fever; Wrist

Salmonella typhi osteomyelitis is an uncommon disease, usually associated with sickle cell anemia and other hemoglobinopathies, as well as with other disease states. In this case, Salmonella osteomyelitis was apparently caused by hematogenous spread after typhoid or enteric fever. After bone debridement, a segmental defect of the midradius resulted. Normal function was restored after radical debridement, intravenous antibiotics, and delayed tricortical iliac crest bone grafting of the segmental defect.

Topics: Adult; Bone Transplantation; Fractures, Spontaneous; Humans; Male; Osteomyelitis; Radiography; Radius; Radius Fractures; Salmonella typhi; Trimethoprim, Sulfamethoxazole Drug Combination

Nocardial osteomyelitis is increasing in both immunocompetent and immunosuppressed patients. We report a case of a Nocardia asteroides infection of the sacrum in a 37-year-old man who was successfully treated surgically.

Topics: Adult; Curettage; Drainage; Humans; Male; Nocardia asteroides; Nocardia Infections; Osteomyelitis; Sacrum; Therapeutic Irrigation; Tomography, X-Ray Computed; Trimethoprim, Sulfamethoxazole Drug Combination

An 18-year-old boy with X-linked chronic granulomatous disease (CGD) developed Aspergillus fumigatus pneumonia and multifocal osteomyelitis. Treatment with amphotericin B resulted in only moderate improvement of the lesions and was accompanied by considerable toxicity. In contrast, administration of the new triazole drug itraconazole led to complete disappearance of all signs of infection. We conclude that itraconazole may be a valuable new drug for treating invasive aspergillosis in patients with CGD, although the duration of treatment remains to be established.

Topics: Adolescent; Amphotericin B; Aspergillosis; Aspergillus fumigatus; Chromatography, High Pressure Liquid; Granulomatous Disease, Chronic; Humans; Itraconazole; Ketoconazole; Lung Diseases, Fungal; Male; Osteomyelitis; Radiography; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Anemia, Sickle Cell; Cefazolin; Child, Preschool; Drug Therapy, Combination; Escherichia coli Infections; Female; Gentamicins; Humans; Metacarpus; Osteomyelitis; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Anti-Infective Agents; Chronic Disease; Drug Combinations; Female; Humans; Male; Osteomyelitis; Penicillinase; Penicillins; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Methicillin and gentamicin resistant strains of Staphylococcus aureus (MRSA) remains a cause of significant morbidity and mortality. Vancomycin is usually effective against these strains, but toxicity and expense are significant drawbacks. Resistance to the new quinolones has been demonstrated in vitro and during clinical therapeutic trials. Trimethoprim-sulphamethoxazole has proved to be effective in vitro against staphylococcal strains that are resistant to gentamicin, methicillin, and quinolones. As determined by time-kill kinetic studies, trimethoprim-sulphamethoxazole was rapidly bactericidal. Clinical evaluation of trimethoprim-sulphamethoxazole against MRSA in patients with osteomyelitis is under study. We believe that our data support the use of trimethoprim-sulphamethoxazole as a potentially economical and effective alternative for the treatment of infections caused by MRSA.

Topics: Drug Combinations; Drug Resistance, Microbial; Humans; Microbial Sensitivity Tests; Osteomyelitis; Staphylococcus aureus; Sulfamethoxazole; Time Factors; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

We conducted a retrospective review of 21 adult patients with osteomyelitis and septic arthritis who were treated with high doses of oral antimicrobial agents, usually after an initial course of intravenous therapy. The mean duration of parenteral and oral therapy was 3.6 days and 43.0 days, respectively. Absorption of oral antibiotics was assessed by determining the trough serum bactericidal titers for the infecting organism; whenever feasible, the dosages were adjusted to achieve trough titers greater than or equal to 1:8. The follow-up period ranged from six to 66 months (mean, 42.4 months). Eighteen of 21 patients had no clinical signs of recurrence after initial therapy. One patient with an infected joint prosthesis developed recurrent infection, and two patients had recurrences accompanied by sequestra. The mean duration of hospitalization was 13.4 days, and the mean duration of outpatient treatment was 31.9 days.

Topics: Administration, Oral; Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Arthritis, Infectious; Cloxacillin; Drug Combinations; Female; Humans; Male; Middle Aged; Osteomyelitis; Recurrence; Staphylococcal Infections; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Fifty-one diabetic patients with osteomyelitis of the foot were studied to determine potential prognostic factors and the role of antimicrobial therapy. Most of the patients were elderly, with diminished pulses, a sensory neuropathy, and a polymicrobial infection. Twenty-seven patients had a good outcome, defined as clinical resolution at the time of the last follow-up examination, without the need for amputation. The mean duration of follow-up for these patients was 19 months. Fifteen patients had a below-knee amputation, and nine had a toe amputation. The absence of necrosis and/or gangrene, the presence of swelling, and the use of antimicrobial therapy active against the isolated pathogens for at least four weeks intravenously, or combined intravenously and orally for 10 weeks, predicted a good outcome. Diabetic foot osteomyelitis, in the absence of extensive necrosis or gangrene, usually responds to antimicrobial therapy without the need for an ablative surgical procedure.

Topics: Amputation, Surgical; Anti-Bacterial Agents; Bacterial Infections; Diabetes Complications; Drug Combinations; Foot Diseases; Humans; Middle Aged; Osteomyelitis; Prognosis; Sulfamethoxazole; Time Factors; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

We present a case of a 45-yr-old black male who developed both meningitis and osteomyelitis due to Yersinia enterocolitica. This particular case was remarkable because the patient made a full recovery without long-term sequelae after therapy with IV chloramphenicol followed by oral trimethoprim-sulfamethoxazole.

Topics: Chloramphenicol; Drug Combinations; Humans; Male; Meningitis; Middle Aged; Osteomyelitis; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Yersinia enterocolitica; Yersinia Infections

The effects of administration for four days of co-trimoxazole (2 X 500 mg tablets daily) and erythromycin stearate (3 X 500 mg tablets daily) on persistently abnormal polymorphonuclear leucocyte (PMNL) migration in six individuals with a history of chronic or recurrent bacterial infections were studied. The effects of co-incubation of PMNL in vitro with both antimicrobial agents at concentrations of 12(-5) and 10(-4) M were also investigated. Two different leucoattractants were used, autologous serum activated with bacterial endotoxin (EAS) and the synthetic chemotactic tripeptide FMLP. In three homosexual males with the acquired immunodeficiency syndrome (AIDS) abnormal PMNL motility was associated with the presence of serum inhibitor(s) of cell migration. In a fourth female subject, with recurrent episodes of acute periodontitis, and intrinsic cellular defect of PMNL migration associated with markedly impaired FMLP-induced degranulation and binding to PMNL was observed. In the remaining two subjects with chronic osteomyelitis, the precise abnormality of PMNL movement was not defined but appeared to be of the cellular intrinsic type. Co-incubation of PMNL with erythromycin, but not cotrimoxazole, at both concentrations tested (10(-5) and 10(-4) M) significantly improved cell migration to EAS, Likewise administration of erythromycin, but not cotrimoxazole, significantly improved PMNL migration to EAS. Improvement or correction of abnormal PMNL motility during antimicrobial chemotherapy with erythromycin may be a useful property of this antimicrobial agent.

Topics: Acquired Immunodeficiency Syndrome; Adult; Bacterial Infections; Cell Movement; Child; Drug Combinations; Erythromycin; Female; Humans; Male; Neutrophils; Osteomyelitis; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Salmonellosis rarely causes osteomyelitis in previously healthy children. A 15-year-old girl was found to have vertebral osteomyelitis due to Salmonella cerro, the first-reported case to the best of our knowledge. Standard treatment with ampicillin and trimethoprim-sulfamethoxazole failed to cure the infection. She recovered after a course of moxalactam therapy and surgery.

Topics: Adolescent; Ampicillin; Cephamycins; Drug Combinations; Female; Humans; Lumbar Vertebrae; Moxalactam; Osteomyelitis; Salmonella Infections; Spondylitis; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination