chronic osteomyelitis

[bethanymcco]

My best friend's husband had chronic osteomyelitis following a bad accident years ago.  Five years ago he went into septic shock from the osteomyelitis and once they got it under control, they put him on a course of antibiotics daily, year round.  In July he broke a tooth and wasn't able to be seen by an oral surgeon.  Within 4 days he had developed osteomyelitis in his jaw.  They were able to treat it (or so they thought), ,but it spread to his ankle.  He was in the hospital for 2 weeks and they never tried to biopsy the ankle because they said they were afraid of doing anything invasive while he was still acutely ill.  His white count was 1.1 when admitted and when they discharged him, it was up to 3.4.  He can't take cillin's of any kind because they cause his blood count to drop, so they started him on clindamycin.  in the hospital, after a week of clindamycin, he spiked a fever up to 102.7 and the doctors said that they wanted to "stay the course" because they said clindamycin is the best choice of meds for osteomyelitis.  He was discharged at the end of August and has remained on the IV clindamycin.  He has had a few good days where he feels well, but most days he feels so sick that he isn't getting out of bed.  His white count is back down to 1.1 and he now haas osteomyelitis in his elbow.  He is being readmitted today, but his doctors continue to insist that clindamycin is the way to go and I'm not a doctor, but it just seems to me that clearly the med isn't working.  He's been on vancomycin in the past and it wasn't hugely helpful, but it was better than the clindamycin has been.  I've read stuff about daptomycin now being successful for treating osteomyelitis.  How do you treat chronic osteomyelitis that isn't responding to the med the doctors are using?  Isn't it time to change antibiotics?  Is it possible that he just needs to add an antibiotic like gentamycin that could cover a gram negative bacteria since they don't know what bacteria they are dealing with?  He's in a small hospital in Maine and getting sicker and nobody seems to know what to do.  Any help at all would be greatly appreciated.  

Thanks.