Chronic osteomyelitis of the zygomatic bone: Back to Benzathine penicillin

Abstract

Osteomyelitis (OM) of zygomatic bone (zyb) is a rare disease, characterized by relapses. We present two patients presenting with chronic discharging sinus over zyb, who had been treated in previous centers, with multiple culture–directed antibiotics, over many months, without cure. We administered intramuscular Benzathine Penicillin 1.2 million IU with oral Vitamin C 1000 mg/day, for a total of six months and achieved successful healing. In chronic OM (cOM), most bacteria are sessile, embedded in biofilm. Sessile bacteria are not picked by a swab; therefore, the bone must be biopsied. Sessile bacteria also do not grow well in culture media. Thus, the conventional cultures do not reflect the true organisms causing cOM. The Minimum Biofilm Eradication Concentration of antibiotics cause toxicity. To eradicate the biofilm bacteria in patients whose computed tomography showed absence of a sequestrum, we administer this regimen. Judicious case selection is necessary. This regimen adds to the clinician’s armamentarium.