Prolonged treatment of chronicPseudomonas aeruginosa osteomyelitis with a combination of two effective antibiotics

Emergence ofPseudomonas aeruginosa resistant to antibiotic monotherapy is one of the causes of therapeutic failure in chronicP. aeruginosa osteomyelitis. We report 15 cases of chronic (>3 months of evolution) biopsy culture provenP. aeruginosa osteomyelitis included in an open prospective study evaluating the efficacy of prolonged treatment (>4 months) with two effective antibiotics in combination. Mean post-treatment follow-up was 38 months. A regimen of cefsulodin in combination with oral ofloxacin was used for six patients, cefsulodin-pefloxacin for three patients, cefsulodin-ciprofloxacin for one patient, piperacillin-pefloxacin for one patient, cefsulodin-fosfomycin for one patient, imipenemciprofloxacin for two patients and amoxicillin-ciprofloxacin-fosfomycin for one patient as home therapy. The clinical cure rate of 73% and bacteriological cure rate of 93% are far superior to those previously described in the literature. We did not observe adverse drug reactions. We think that a prolonged use of two effective antibiotics in combination is a safe and improved therapeutic schedule for chronicP. aeruginosa osteomyelitis.