We undertook a prospective, randomized comparison of oral
ciprofloxacin with standard parenteral
therapies for the treatment of biopsy-proven
osteomyelitis caused by susceptible organisms. Following surgical
debridement, the
ciprofloxacin patients received 750 mg twice a day, and the other patients received a broad-spectrum
cephalosporin or a
nafcillin-
aminoglycoside combination intravenously (i.v.). There were 31 evaluable patients in the
ciprofloxacin group, treated an average of 56 days, and 28 in the i.v. group, treated an average of 47 days. Clinical success rates were 24 of 31 (77%) for the
ciprofloxacin group and 22 of 28 (79%) for the i.v. group. Of the seven failures in the
ciprofloxacin group, one was due to a persistent Klebsiella pneumoniae
infection and six were due to relapse of the
infection within 1 year of
therapy. Of the six failures in the i.v. group, one was due to an Enterobacter aerogenes strain which emerged resistant and five were due to relapse. The most troublesome etiology was polymicrobial
osteomyelitis involving Pseudomonas aeruginosa, in which five of six (83%) regimens failed. Adverse reactions occurred infrequently, i.e., in 1 of 31 (3%) of the
ciprofloxacin patients and in 4 of 28 (14%) of the i.v. patients, yet all reactions responded to
therapy and none required protocol deviation. Our data indicate that oral
ciprofloxacin monotherapy is as safe and effective as conventional parenteral
therapy in cases of
osteomyelitis caused by susceptible organisms.