Cloxacillin in treatment of acute osteomyelitis.

It has been said that when treating acute osteomyelitis, in this the era of antibiotic-resistant bacteria, the antibiotic given to the patient when first seen is usually chosen by "inspired" guesswork (Mercer, 1964). If an antibiotic were available to which all commonly encountered pathogens were sensitive then this guesswork would be eliminated. It would be unnecessary to change an antibiotic or give a combination of antibiotics when organism-sensitivity reports became available (Neligan and Elderkin, 1965). Mann (1963) attributes the progression of the disease from the acute to the chronic phase in 7 out of 59 cases reviewed in 1963 to the initial use of the "wrong antibiotic " (as shown by later sensitivity reports). It is probable that many cases of chronic osteomyelitis, often associated with the appearance of antibiotic-resistant organisms, are due to inadequate antibiotic therapy and delay in the onset of treatment. For the treatment of acute osteomyelitis an antibiotic must have the following properties. (1) It must be effective against the organisms most often encountered. Of 709 cases of acute osteomyelitis collected from hospital records and from the literature, where organisms had been isolated, 617 (87%) were due to staphylococcal infection, 46 (6.5 %) were streptococcal, and the remaining 46 (6.5%) included a wide range of organisms. (2) It is preferable to avoid multiple daily injections in children, and therefore an oral antibiotic is required. The antibiotic of choice must be readily absorbed from the gastrointestinal tract, producing effective blood and tissue levels. (3) It should be bactericidal as well as bacteriostatic. (4) It should produce no adverse side-effects even after prolonged therapy. (5) Prolonged therapy must not lead to the formation of resistant strains.