Chronic Osteomyelitis Caused by Staphylococcus aureus: Controlled Clinical Trial of Nafcillin Therapy and Nafcillin-Rifampin Therapy

Authors:
  • CNCarl W. Norden
    Carl W. Norden
  • RBRichard Bryant
    Richard Bryant
  • DPDarwin Palmer
    Darwin Palmer
  • JMJohn Z. Montgomerie
    John Z. Montgomerie
  • JWJoseph Wheat
    Joseph Wheat
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Abstract
A controlled trial of treatment of chronic osteomyelitis caused by Staphylococcus aureus compared nafcillin alone with nafcillin plus rifampin for a six-week period. Treatment was well tolerated, the only adverse effect being mild neutropenia in four of 18 patients; no toxicity was observed from rifampin. Eight of ten patients in the combined treatment group had a favorable clinical response (with follow-up of two to four years) as compared to four of eight in the nafcillin group (P = .2). Despite the failure to show a statistically significant advantage of rifampin plus nafcillin, we conclude that the combination, along with appropriate surgery, should be considered for patients with chronic staphylococcal osteomyelitis.