Bone and joint
infections have traditionally required long-term parenteral antimicrobial
therapy, which is often expensive and inconvenient. Because of their excellent absorption and tissue penetration, oral
quinolones may provide an alternative to parenteral
therapy. This multicenter study was designed to evaluate the efficacy and safety of oral
fleroxacin in
osteomyelitis and
septic arthritis. A total of 96 patients with either
septic arthritis or acute or chronic
osteomyelitis from 17 U.S. centers were enrolled in a noncomparative study using oral
fleroxacin 400 mg per day. Patients with implantable devices were excluded. Proof of
infection for evaluability required clinical findings in addition to bacteriologic recovery of a susceptible organism from synovial fluid or bone. Treatment lasted 2-12 weeks. Clinical and bacteriologic outcomes were judged at the conclusion of
therapy and in the 6-week follow-up period. A total of 30 patients qualified for efficacy analysis (26
osteomyelitis, 4
septic arthritis). Bacteriologic cure was achieved in 77% of the
osteomyelitis group and 50% of the
septic arthritis group. Clinical cures were reported in 54% of the
osteomyelitis group and 50% of the
septic arthritis group. Staphylococcus aureus was the most frequently recovered pathogen (62% evaluable cases). Safety was evaluated in 96 patients. The most common side effects were
nausea,
vomiting, and skin reactions. Oral
fleroxacin may be a safe, effective, and certainly less expensive alternative to standard intravenous antimicrobial
therapy in patients with bone and joint
infections.