ORIGINAL ARTICLE

Fosfomycin for the initial treatment of acute haematogenous osteomyelitis

N Corti¹, F H Sennhauser², U G Stauffer³, D Nadal¹

¹ Division of Infectious Diseases, University Children’s Hospital of Zurich, Zurich, Switzerland
² Department of Paediatrics, University Children’s Hospital of Zurich
³ Department of Paediatric Surgery, University Children’s Hospital of Zurich

Correspondence to:
Correspondence to:
Dr D Nadal, Division of Infectious Diseases, University Children’s Hospital of Zurich, Steinwiesstrasse 75, CH-8032 Zurich, Switzerland;
david.nadal{at}kispi.unizh.ch

Background and Aims: At our institution there has been a dichotomous antimicrobial treatment behaviour for acute haematogenous osteomyelitis (AHOM) since 1984. The surgical department favoured fosfomycin as initial choice and the medical department ß lactams. We aimed to compare the performance of both strategies.

Methods: Data from patients discharged with the diagnosis of AHOM between January 1984 and January 1998 were gathered from the charts by means of a questionnaire. Patients receiving fosfomycin treatment (FT) were compared with those receiving fosfomycin plus other antimicrobials (FT+) and those receiving no fosfomycin treatment (NFT).

Results: A total of 103 patients aged 0.1–15.5 years (mean 6.5, median 6.9) with AHOM received no surgical treatment initially. In 23 (22.3%) FT was instilled initially, in 47 (45.6%) FT+, and in 33 (32.0%) NFT. The pathogen was established in 30%, 36%, and 42% of FT, FT+, and NFT patients, respectively, Staphylococcus aureus being the predominant isolate. Mean C reactive protein levels and erythrocyte sedimentation rates normalised in all treatment groups after two and four weeks, respectively. The mean duration of intravenous antimicrobial treatment in FT patients was 2.5 weeks, in FT+ patients 3.1 weeks, and in NFT patients 3.8 weeks (p < 0.05), whereas the mean duration of intravenous plus oral treatment was comparable (7.1 v 6.8 v 6.5 weeks).

Conclusions: The leucocyte penetrating fosfomycin performed similarly to extracellular ß lactams in the treatment of AHOM. Intravenous treatment for longer than 2.5 weeks offered no advantage.

Keywords: acute haematogenous osteomyelitis; fosfomycin; ß lactams

Abbreviations: AHOM, acute haematogenous osteomyelitis; CRP, C reactive protein; ESR, erythrocyte sedimentation rate; FT, fosfomycin treatment; FT+, fosfomycin plus other antimicrobials; NFT, no fosfomycin treatment

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ADC Online, 17 Jul 2003 [Full text]