The development of antimicrobial
therapy for
osteomyelitis is reviewed. The disease, especially when chronic, is notoriously resistant to
antibiotic therapy. The duration of disease defining chronicity has decreased considerably in the last 30 years. Successful therapy reflects increased appreciation of the combined roles of surgical
debridement and prolonged antimicrobial courses. Parenteral high-dose
beta-lactam agents yield clinical success for many patients with chronic
osteomyelitis, particularly with prolonged administration and surgical
debridement. Over the last decade, the initial success of oral
quinolone therapy for gram-negative
osteomyelitis was exploited further for staphylococcal diseases. Open clinical trials and comparative trials suggest success rates approximating those achieved with parenteral
beta-lactams, particularly with appropriate surgery and adequate
duration of therapy. The early results with
quinolones and
rifampin for
prosthesis-related infection are encouraging. Overall, oral
quinolones provide a new and frequently proportionate response to a disease that is difficult to treat.