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Abstract：
Chronic osteomyelitis in adults is managed with prolonged courses of intravenous antibiotics in conjunction with surgical debridement of necrotic bone. Over the past 40 years, there has been no paradigm shift in this approach, as randomized controlled trials of this standard of care compared to alternatives such as prolonged oral antibiotics are scarce. However, there have been many small trials, case reports, and review papers evaluating the effectiveness of oral treatment for chronic osteomyelitis. The oral route for infections requiring prolonged treatment is intuitively and practically more favorable due to several advantages, the most important of which is the avoidance of long-term IV antimicrobial therapy with its complications, inconvenience, and cost. In this paper, we review the literature evaluating oral antibiotic therapy in the management of chronic bone infections since 1975. The majority of osteomyelitis infections are caused by Staphylococcus aureus, hence we focus on its treatment using oral antibiotics; however, we also emphasize subpopulations of patients with diabetes, implanted hardware, and with less common bacterial organisms. The primary objective of this review is to promulgate clinical recommendations on the use of oral antibiotics in bone infections in the context of initial therapy, transition from intravenous therapy, and the role of chronic suppression. The secondary objective is to summarize current knowledge of the specific oral antimicrobial agents that are commonly utilized, together with a synopsis of the available literature pertaining to their pharmacokinetic/pharmacodynamic properties and duration of therapy in bone infection.
摘要：
成人慢性骨髓炎可以通过延长静脉内抗生素疗程以及坏死骨的手术清创术来治疗。在过去的40年里,这种方法没有范式转变，因为与长期口服抗生素等替代治疗相比，这种标准治疗的随机对照试验很少。然而,有许多小试验，病例报告,并回顾评价口服治疗慢性骨髓炎的有效性的论文。需要长期治疗的感染的口腔途径由于几个优点而直观和实际上更有利。其中最重要的是避免长期静脉抗菌治疗及其并发症，不便,和成本。在本文中,我们回顾了自1975年以来评价口服抗生素治疗治疗慢性骨感染的文献.大多数骨髓炎感染是由金黄色葡萄球菌引起的，因此，我们专注于使用口服抗生素治疗；然而，我们还强调糖尿病患者的亚群，植入硬件，和不太常见的细菌生物。这篇综述的主要目的是在初始治疗的背景下，发布关于在骨感染中使用口服抗生素的临床建议。从静脉治疗过渡，和慢性抑制的作用。次要目标是总结目前常用的特定口服抗菌剂的知识，以及有关其药代动力学/药效学特性和骨感染治疗持续时间的现有文献摘要。
