NEW YORK (Reuters Health) – An oral regimen containing rifampicin and ofloxacin is effective and well-tolerated for elderly diabetic patients with infected foot ulcers associated with osteomyelitis of the feet, French investigators have found.
Dr. Eric Senneville of Hopital Dron in Tourcoing and associated treated 17 such patients with rifampicin 600 mg bd plus ofloxacin 200 mg tds for a median of 6 months.
In the Journal of Antimicrobial Chemotherapy for December 2001, they report that 15 patients (88.2%) were cured, "defined as disappearance of all signs and symptoms of infection at the end of the treatment and absence of relapse during follow-up." Cure was maintained in 13 patients (76.5%) for a median of 22 months after treatment was stopped.
Nine patients (47%) reported adverse effects, mainly gastrointestinal and neurological in nature, but none required discontinuation of the study medication.
More than 85% of the pathogens isolated from ulcers and bone were gram-positive cocci. Two patients with staphylococcal osteomyelitis did not respond to rifampicin/ofloxacin combination therapy.
In comments to Reuters Health, Dr. Senneville said: "The management of diabetic foot osteomyelitis should take into account the classic rules of the treatment of chronic osteomyelitis."
Multi-resistant bacteria were isolated from four patients. This "might be the result of prolonged antibiotic therapy and could argue for shorter courses of treatment such as 3 months or less," they write.