[Antibacterial chemotherapy in anaerobic osteomyelitis caused by gunshot wounds]

Thirty three patients with a 7-year history of chronic gunshot osteomyelitis were examined. Non-sporogenic anaerobes were isolated from 28 patients. Gram-positive cocci and gram-negative rods predominated in the anaerobic microflora. Radical surgical interventions combined with adequate antibacterial chemotherapy yielded satisfactory results. The postoperative cavities were drained to provide aerobic conditions in all the parts. Antibacterial drugs and in particular dioxidine solutions and KF were used locally. When antibioticograms were available 7 to 10 days after, the antibiotics in combination with enzymes such as terrylitin and lidase were used with constant irrigation of wounds with furacillin or boric acid solutions. In the empirical therapy, the following scheme was most frequently used: 600 mg of lincomycin, thrice, intramuscularly; 80 mg of gentamicin, thrice, intramuscularly and as an obligatory agent 500 mg of trichopol, thrice, orally. After availability of the antibioticograms the use of the antibiotics was adjusted and continued up to 10 to 12 days. In severe cases 0.1% solution of dioxidine was used intravenously drop-wise in a dose of 300 mg 2 times a day as well as tiberal or clindamycin, intravenously, drop-wise. The antibacterial drugs were added to the drainage until the latter was removed. Relapses of the disease over 4 years were observed only in 3 out of 26 operated patients.