Bone penetration of antibiotics

Osteomyelitis is caused by bacterial pathogens and, less frequently, by other infectious agents. Treatment of osteomyelitis should include a course of antimicrobial therapy with a bactericidal agent. This therapy should be directed at the causative bacteria isolated by bone biopsy and culture, not by wound swab cultures above the infected bone. The bactericidal agent should be demonstrated effective against the organism isolated from bone and should penetrate the bone in sufficient concentrations. Many studies have assessed bone penetration of antimicrobials, but methodological problems must be addressed. Penicillins, cephalosporins, aminoglycosides, erythromycin, lincomycin and clindamycin, and metronidazole have all been evaluated.