title: Prolonged oral antibiotic suppression in osteomyelitis and associated outcomes in a Veterans population.
abstract: OBJECTIVE
  Prolonged oral antimicrobial suppression has been suggested as an alternative treatment for patients with prosthetic joint infections who are unable or unwilling to undergo surgical intervention; however, little data exists for utilizing this approach in patients with chronic osteomyelitis and no artificial hardware.
  
  
  METHODS
  We retrospectively reviewed the medical records of all patients over a 5-year time frame who were treated with chronic oral antibiotic suppression for osteomyelitis and who had no artificial hardware. Clinical outcomes, risk factors for treatment failure, and adverse drug reactions were evaluated.
  
  
  RESULTS
  A total of 20 patients were included for evaluation, of which 12 (60%) were able to achieve successful suppression of disease for a mean duration of 778 ± 408 days after discontinuation. Diabetic patients were found to be at higher risk for treatment failure (p = 0.0281). We also identified a high rate of adverse events (25%) attributable to suppressive medications. Despite elevated inflammatory markers contributing to the decision to initiate antibiotic suppression in the majority of patients, few were able to achieve normal values throughout suppressive therapy.
  
  
  CONCLUSIONS
  Further randomized, controlled studies are needed to determine the utility of antibiotic suppression. However, prolonged oral antibiotic suppression may be a reasonable last-line treatment alternative for chronic osteomyelitis, even in the absence of artificial hardware, for patients who are unwilling or unable to undergo optimal surgical intervention.
authors.affiliation: Assistant Professor, California Northstate University, College of Pharmacy, Rancho Cordova, CA mnowak@calpharm.org.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Nowak
authors.affiliation: Infectious Diseases Clinical Pharmacist, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI.
authors.forename: Jamie S
authors.initials: JS
authors.lastname: Winner
authors.affiliation: Professor and Chief of Infectious Diseases, Clement J. Zablocki Veterans Affairs Medical Center and the Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Beilke
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000175:diagnosis* / Q000188:drug therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014728:Veterans
chemical_list: D000900:Anti-Bacterial Agents