Primary Article

Chronic Osteomyelitis Caused by Staphylococcus aureus: Controlled Clinical Trial of Nafcillin Therapy and Nafcillin-Rifampin Therapy

Authors: CARL W. NORDEN MD, RICHARD BRYANT MD, DARWIN PALMER MD, JOHN Z. MONTGOMERIE MD, JOSEPH WHEAT MD Chronic Staphylococcal Osteomyelitis Study Group 1 From the Departments of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pa. 2 From the Departments of Oregon Health Sciences University, Portland 3 From the University of New Mexico School of Medicine and Veterans Administration Medical Center, Albuquerque 4 From the University of Southern California, Rancho Los Amigos Medical Center, Downey 5 From the University of Indiana, Indianapolis

Abstract

ABSTRACT A controlled trial of treatment of chronic osteomyelitis caused by Staphylococcus aureus compared nafcillin alone with nafcillin plus rifampin for a six-week period. Treatment was well tolerated, the only adverse effect being mild neutropenia in four of 18 patients; no toxicity was observed from rifampin. Eight of ten patients in the combined treatment group had a favorable clinical response (with follow-up of two to four years) as compared to four of eight in the nafcillin group (P=.2). Despite the failure to show a statistically significant advantage of rifampin plus nafcillin, we conclude that the combination, along with appropriate surgery, should be considered for patients with chronic staphylococcal osteomyelitis.

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References