Because of the serious nature of a possible associated bacteremia in acute infections, aggressive therapy is necessary until acute symptoms resolve and blood cultures become negative. Treatment of gram-negative osteomyelitis requires an accurate identification of the organism and antimicrobial susceptibility. Oral ciprofloxacin is an effective and inexpensive choice for treating bone infections caused by Enterobacteriaceae. Furthermore, recent studies have shown that ciprofloxacin, ofloxacin, and pefloxacin have been effective in treating osteomyelitis caused by multiply resistant gram-negative bacteria. Because of reports of the development of resistance, however, patients should be carefully monitored when ciprofloxacin is used as monotherapy in pseudomonal osteomyelitis.
Ceftazidime is another potent antipseudomonal agent.
Because of rising hospital costs, alternatives to an extended hospital stay for parenteral treatment of osteomyelitis in otherwise healthy patients are being sought. For patients who require a complete regimen of I.V. antibiotics, outpatient therapy should be considered. Patients should be educated in the care and use of the catheter while still in the hospital. Furthermore, drug toxicity and clinical response should be closely monitored. Administration of antibiotics during clinic visits or by a home health agency can substantially reduce costs.