J Bone Jt Infect 2020; 5(1):16-24. doi:10.7150/jbji.40667

Review

Oral Flucloxacillin for Treating Osteomyelitis: A Narrative Review of Clinical Practice

Helga Preiss1*, Philipp Kriechling2*, Giulia Montrasio1, Tanja Huber3, İmke Janssen4, Andreea Moldovan5, Benjamin A. Lipsky6, İlker Uçkay7✉

1. Internal Medicine, Baden Hospital, Baden, Switzerland
2. Orthopaedic Surgery, Balgrist University Hospital, Zurich, Switzerland
3. Hospital Pharmacy, Balgrist University Hospital, Zurich, Switzerland
4. Internal Medicine, Zollikerberg Hospital, Zollikon, Switzerland
5. Infectiology, St. Constantin Hospital, Braşov, Romania
6. Department of Medicine, University of Washington, Seattle, Washington, USA
7. Infectiology, Balgrist University Hospital, Zurich, Switzerland
*equal contribution as first authors

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Citation:
Preiss H, Kriechling P, Montrasio G, Huber T, Janssen İ, Moldovan A, Lipsky BA, Uçkay İ. Oral Flucloxacillin for Treating Osteomyelitis: A Narrative Review of Clinical Practice. J Bone Jt Infect 2020; 5(1):16-24. doi:10.7150/jbji.40667. Available from http://www.jbji.net/v05p0016.htm

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Abstract

Flucloxacillin (FLU) administered by the oral route is widely used for treating various infections, but there are no published retrospective or prospective trials of its efficacy, or its advantages or disadvantages compared to parenteral treatment or other antibiotics for treating osteomyelitis. Based on published in vitro data and expert opinions, other non-β-lactam oral antibiotics that have better bone penetration are generally preferred over oral FLU. We reviewed the literature for studies of oral FLU as therapy of osteomyelitis (OM), stratified by acute versus chronic and pediatric versus adult cases. In striking contrast to the prevailing opinions and the few descriptive data available, we found that treatment of OM with oral FLU does not appear to be associated with more clinical failures compared to other oral antibiotic agents. Because of its narrow antibiotic spectrum, infrequent severe adverse effects, and low cost, oral FLU is widely used in clinical practice. We therefore call for investigators to conduct prospective trials investigating the effectiveness and potential advantages of oral FLU for treating OM.

Keywords: oral flucloxacillin, osteomyelitis, literature review, clinical treatment, clinical remission