The treatment of chronic osteomyelitis with clindamycin

Clindamycin was given orally over prolonged periods to 12 patients with chronic osteomyelitis. It was well tolerated with only minor side effects and no major toxicity. Clinical and bacteriological cure occurred in five patients and improvement was noted in another five. It appears less effective than either lincomycin or cloxacillin but, because of the complex nature of both the disease and its treatment, strict comparisons are very difficult.     

Pefloxacin in the treatment of chronic urinary infection]

This study aimed at determining sensitivity of the hospital isolates to pefloxacin compared with other urinary antiseptics and assessment of its efficiency in the treatment of the chronic urinary infections. Disc diffusion technique was used to determine bacterial sensitivity to pefloxacin and other agents. Bacteria were isolated from the urine of the hospitalized patients. All tested strains were sensitive to pefloxacin. Its sensitivity exceeded in vitro 80%. Fifteen patients full sensitive to pefloxacin were treated. No bacteria were seen in the urine of 8 patients in two bacteriological cultures following the treatment, 3 patients stopped therapy due to adverse reactions, and no sterile urine was noted in 4 patients despite following a complete cycle of therapy.     

Various methods of using lincomycin for treating acute and chronic hematogenic osteomyelitis in children]

Comparative data on the treatment of 209 children with acute and chronic hematogenic osteomyelitis are presented; 128 patients hospitalized before 1974 were treated with antibiotics, mainly penicillin and streptomycin without sensitivity testing. From 1974 81 children were treated with lincomycin; 80 per cent of the isolates were sensitive to this antibiotic. In lincomycin therapy the method of electrophoresis on the disease focus, intrabone administration of the drug and administration of the drug into the bone cavity together with the blood clot during surgical interventions in cases with chronic hematogenic osteomyelitis were used. A marked decrease in the rate of the chronic forms of the disease was registered (from 77.2 to 8.8 per cent).     

Surgical treatment of osteomyelitis

Chronic osteomyelitis is refractory to nonsurgical treatment due to a resilient, infective nidus that harbors sessile, matrix-protected pathogens bound to substrate surfaces within the wound. Curative treatment mandates physical (surgical) removal of the biofilm colony, adjunctive use of antibiotics to eliminate residual phenotypes, and efforts to optimize the host response throughout therapy. Patient selection, therapeutic options, and the treatment format are determined by the Cierny/Mader staging system, while reconstruction is governed by the integrity/stability of the affected bone(s) and quality/quantity parameters of the soft-tissue envelope.     

The muscle flap in the treatment of chronic lower extremity osteomyelitis: results in patients over 5 years after treatment.

Preliminary reports have indicated that debridement of the bony sequestrum followed by muscle-flap coverage allows successful treatment of chronic osteomyelitis. To determine the long-term effectiveness of this procedure, 34 consecutive patients with chronic osteomyelitis of the distal lower extremity treated with debridement, a 10- to 14-day course of culture-specific antibiotics, and immediate muscle-flap coverage were evaluated. Patients were treated from 1979 through 1984, and long-term (greater than 5 years) follow-up was available for 27 (79 percent). Twenty-three (85 percent) of these patients underwent microvascular muscle transplantation (gracilis or latissimus dorsi), and four underwent local muscle flaps (gastrocnemius or soleus) for immediate wound coverage. Twenty-four patients (89 percent) healed and were without recurrence over long-term (greater than 5 years, mean 7.4 years) follow-up. Of the three with recurrence, two were cured (greater than 5 years follow-up) after additional muscle-flap procedures. Thus the overall success rate was 96 percent, with a minimum 5-year follow-up. Guidelines for muscle-flap selection and treatment techniques in current use are presented. Debridement and immediate muscle-flap coverage provide effective, single-stage treatment of chronic osteomyelitic wounds and allow antibiotics to be restricted to short-term use. Furthermore, muscle flaps covered with skin grafts provide durable coverage while allowing subsequent ancillary procedures (i.e., bone grafts) to be performed under the flaps.     

Use of rifamethoprim in acute and chronic respiratory tract diseases]

Rifamethoprim is a new formulation containing rifampicin and trimethoprim. Its efficacy was studied in the treatment of a group of patients with various nonspecific diseases of the lungs. It was shown to be highly active against a broad spectrum of pathogens. With inclusion of trimethoprim to the formulation it appeared possible to markedly lower the bacterial ability to develop resistance to rifampicin, which solved the problem of long-term antibiotic use. The unique pharmacokinetic properties of rifampicin such as its capacity to penetrating into the sputum, lung tissues and cells make rifamethoprim be the drug of optimal choice in the treatment of respiratory diseases.     

Carbenicillin in the treatment of acute and chronic bacterial pneumonias]

A total of 50 patients suffering from acute and chronic bacterial pneumonia were treated with sodium carbenicillin. The bacteriological analysis of the sputum showed that Str. pneumoniae predominated in the monoculture or its association with other bacteria. Connection of the results of the bacteriological analysis with the clinical efficiency of the therapy was studied. When carbenicillin was administered intramuscularly in a dose of 1 gm, its therepeutic effect was maintained in the blood for 4 to 6 hours. A satisfactory clinical effect was registered in 41 out of 50 patients treated with carbenicillin in a daily dose 4--6 gm for 8--10 days. No toxic effect of carbenicillin on the parenchimatous organs and peripheral blood was noted.     

The simple and effective choice for treatment of chronic calcaneal osteomyelitis: neurocutaneous flaps

The authors describe their experience with the use of distally based saphenous and sural neurofasciocutaneous flaps for the treatment of calcaneal osteomyelitis in nine cases. Aggressive débridement of all nonviable and poorly vascularized tissue and coverage with a distally based neurofasciocutaneous flap were coupled with a thorough antibiotic course in all cases. The deepithelized peripheral parts of all flaps were buried in the bone cavities after bone débridement. Follow-up periods ranged from 15 to 27 months. All flaps survived completely. All of the wounds except one healed completely. These flaps have adequate blood flow for the management of chronic bone infections. They also have many advantages, such as easy quick elevation, short operative time, and acceptable donor-site morbidity. Moreover, patients treated with neurocutaneous flaps do not require debulking procedures or special shoes. Reconstruction with neurocutaneous flaps after radical débridement is a versatile alternative to the use of local or distant muscle flaps and calcanectomy procedures for patients with osteomyelitis of the os calcis.