Osteomyelitis is an inflammation of bone caused by a pyogenic organism. It may remain localized or may spread through the bone to involve the marrow, cortex, cancellous tissue and periosteum. The most common treatments for osteomyelitis are antibiotics and surgery to remove portions of bone that are infected or dead . For optimal results, antibiotic therapy must be started early, with antimicrobial agents administered for at least 4 to 6 weeks. However, despite continued research, most aspects of antibiotic treatment for osteomyelitis remain to be clearly understood. Indeed current data are sparse and no consensus guidelines are currently available . Thus the treatment of osteomyelitis is still mostly based on expert opinions. Currently, clindamycin is an antimicrobial agent widely used for the treatment of bone and joint infections because of its activity against staphylococci, streptococci and anaerobic bacteria . In addition, clindamycin has high levels of joint and bone penetration [4–6] and inhibits biofilm formation and bacterial adherence [7, 8]. Although its efficacy has been established in several experimental models [9, 10], only a few series on the clindamycin treatment of human bone and joint infections have been reported [11–13]. The current recommendation for the dosage of oral clindamycin is 150–300 mg every 6 h for moderately severe infection and 300–450 mg every 6 h for severe infection . The dosage of clindamycin intravenously administered should be 600 mg–1.2 g day−1 in two, three or four equal doses for serious infections and for more severe infections 1.2–2.7 g day−1 in two, three or four equal doses. Clindamycin dosage modification is not necessary in patients with renal or hepatic insufficiency .
In the present study, we have developed a population pharmacokinetic model for clindamycin used in adults treated for bone and joint infections to study the influence of covariates (body weight, age, co-treatments) on pharmacokinetics. The main goal was then to optimize the dose of clindamycin given to patients with osteomyelitis.