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Extended-interval aminoglycoside dosing for treatment of enterococcal and staphylococcal osteomyelitis

A Christie Graham1, Renee-Claude Mercier, Louis E Achusim

  • 1School of Pharmacy, University of Wyoming, Laramie, WY, USA.

The Annals of Pharmacotherapy
|April 16, 2004
PubMed
Abstract

Insights

Extended-interval aminoglycoside dosing (EIAD) shows promise for treating gram-positive osteomyelitis, achieving clinical cure in most patients. However, careful monitoring for nephrotoxicity is crucial due to its high incidence, especially with combination vancomycin therapy.

Area of Science:

  • Infectious Diseases
  • Pharmacology
  • Orthopedics

Background:

  • Gram-positive osteomyelitis necessitates prolonged antibiotic treatment, often managed outpatient.
  • Traditional aminoglycoside regimens require multiple daily doses, posing inconvenience.
  • Limited data exist on extended-interval aminoglycoside dosing (EIAD) for this condition.

Purpose of the Study:

  • To assess the safety and efficacy of EIAD in treating gram-positive osteomyelitis.
  • To evaluate clinical and microbiologic outcomes.
  • To determine the incidence of nephrotoxicity and ototoxicity with EIAD.

Main Methods:

  • Retrospective chart review of adult patients with gram-positive osteomyelitis treated with EIAD.
  • Data collected from the University of New Mexico Home IV Antibiotic Clinic.
  • Outcomes included clinical cure, microbiologic eradication, nephrotoxicity, and ototoxicity.

Main Results:

  • Fifteen patients (16 events) were analyzed; Enterococcus spp. was most common.
  • Clinical cure achieved in 75% of patients; 3 achieved cure without device removal.
  • Seven patients developed nephrotoxicity, with higher risk in males (p=0.04); 5 received concurrent vancomycin.

Conclusions:

  • EIAD can successfully manage most gram-positive osteomyelitis cases.
  • A significant proportion of patients experienced nephrotoxicity, linked to prolonged aminoglycoside exposure.
  • Further research is needed to optimize EIAD protocols and mitigate renal toxicity risks.

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