Chronic staphylococcal osteomyelitis: treatment with regimens containing rifampin

Experience with rifampin as a component of combination antibiotic therapy for chronic staphylococcal osteomyelitis was reviewed. These data included the preliminary results of a randomized, prospective trial of parenteral nafcillin alone vs. parenteral nafcillin plus oral rifampin; the results of use of rifampin in combination with other oral antibiotics for the treatment of chronic staphylococcal osteomyelitis; and experience with rifampin regimens at the Oregon Health Sciences University. A total of 28 patients are described in this report; 70% of those who received regimens including rifampin experienced an apparent cure of infection. Most patients whose infections were not cured had inadequate surgical therapy or were also infected with other bacteria. Staphylococcus aureus was eradicated from the sinus drainage of all but one patient. Although these results are encouraging, a larger number of patients and a longer follow-up period are required for an adequate evaluation of the place of rifampin in therapy for chronic staphylococcal osteomyelitis.