Fluoroquinolones versus beta-lactam based regimens for the treatment of osteomyelitis: a meta-analysis of randomized controlled trials.
METHODS
A meta-analysis of randomized control trials.


OBJECTIVE
To compare fluoroquinolones to beta-lactams for the treatment of osteomyelitis.


BACKGROUND
Treatment of osteomyelitis remains a real challenge in medicine necessitating the use of broad-spectrum antibiotics, because of the variety of the pathogens causing the infection and the fact that the infected bone may become necrotic and avascular, preventing systemic antibiotics from adequately penetrating to the infection site.


METHODS
A literature search was performed by 2 reviewers independently (PubMed database and the Cochrane Central Register of Controlled Trials).


RESULTS
We identified 7 studies eligible for inclusion in our meta-analysis; ciprofloxacin, ofloxacin, and pefloxacin were used in 3, 3, and 1 study, respectively, while various beta-lactams (mainly in the intravenous form) were used as comparators. There was no difference in treatment success for osteomyelitis between fluoroquinolones and beta-lactams [194 patients, fixed effect model (FEM), odds ratio (OR) = 0.99, 95% confidence interval (CI) 0.51-1.91], bacteriological success (201 isolates, FEM, OR = 0.88, 95% CI = 0.45-1.70), superinfections (173 patients, FEM, OR = 1.75, 95% CI = 0.63-4.90), relapses (153 patients, FEM, OR = 1.23, 95% CI = 0.46-3.31), or adverse events (170 patients, FEM, OR = 0.47, 95% CI = 0.21-1.06).


CONCLUSIONS
Fluoroquinolones are as effective as beta-lactams for the treatment of osteomyelitis and can be considered as a useful alternative in the physician's armamentarium. The value of fluoroquinolones for the treatment of osteomyelitis lies in the fact that they can be administered in an outpatient setting. However, they should be used with caution, so as to preserve their activity against increasingly resistant bacteria.
Karamanis
Eirinaios M
EM
Alfa Institute of Biomedical Sciences (AIBS), Athens, Greece.
Matthaiou
Dimitrios K
DK
Moraitis
Lampros I
LI
Falagas
Matthew E
ME
D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D024841:Fluoroquinolones / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D016017:Odds Ratio; D010019:Osteomyelitis / Q000188:drug therapy* / Q000382:microbiology; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D018570:Risk Assessment; D015163:Superinfection / Q000209:etiology; D016896:Treatment Outcome; D047090:beta-Lactams / Q000009:adverse effects / Q000627:therapeutic use*
D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones; D047090:beta-Lactams