Semin Plast Surg 2009; 23(2): 090-099
DOI: 10.1055/s-0029-1214161
© Thieme Medical Publishers

Systemic Antimicrobial Therapy in Osteomyelitis

Henry S. Fraimow1
  • 1University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, Division of Infectious Diseases, Cooper University Hospital, Camden, New Jersey
Further Information

Publication History

Publication Date:
30 April 2009 (online)


Appropriately designed antibiotic regimens are critical to the management of all stages of osteomyelitis, although goals of therapy may vary in different stages of infection. The most important consideration for antibiotic selection is spectrum of action. Route of administration by intravenous or oral route is less important than drug levels that are achievable at the site of infection. Outpatient parenteral therapy and use of oral agents has simplified delivery of long-term treatment regimens. There are few high-quality studies that compare specific treatment regimens or durations of therapy, and recommendations for drugs and duration of antibiotic therapy are based on expert opinion, case series, and extrapolations from animal models. Intravenous β-lactams are the treatment of choice for methicillin-susceptible Staphylococcus aureus, but there are also oral options available. Vancomycin has been the treatment of choice for methicillin-resistant Staphylococcus aureus osteomyelitis, but there are several newer parenteral and oral agents for treatment of methicillin-resistant Staphylococcus aureus including linezolid and daptomycin. Rifampin combined with other staphylococcal agents may increase cure rates, especially for device-associated infections. Oral fluoroquinolones and parenteral β-lactam agents can be used for treatment of gram-negative osteomyelitis, but increasing resistance has complicated management of these infections.


Henry S Fraimow, M.D. 

Division of Infectious Diseases, Cooper University Hospital

401 Haddon Avenue, Room 274, Camden, NJ 08103