Outpatient Antibiotic Therapy for Osteomyelitis

To the Editor.—  The March 28, 1986, issue of JAMA contained an article offering an economic analysis of outpatient therapy for osteomyelitis.¹ This article is now being distributed by representatives of the Smith Klein & French pharmaceutical company for the purpose of encouraging the use of the cephalosporin antibiotic cefonicid (Monocid) in this setting. In their introduction, the authors justify their analysis by noting that "a new... cephalosporin antibiotic, cefonicid sodium, has been shown to be effective in treating osteomyelitis in the outpatient setting." This statement is supported by reference to a clinical trial published in a supplement to Reviews of Infectious Diseases underwritten by Smith Klein & French.² This clinical trial examined (in an uncontrolled fashion) cefonicid therapy for osteomyelitis in 15 patients, 12 of whom completed therapy. The investigators in this clinical trial appropriately noted the limitations of their study: small numbers, no comparison group, lack