To the Editor:

I read with interest the Current Concepts review on osteomyelitis. I saw only a very few cases during the time I was in active practice until in 1998 when I made my first trip to a mission hospital in Kenya, Kijabe Medical Center. I returned to this facility annually, for approximately three weeks, through 2002.

During the time that I was at Kijabe, I saw more chronic osteomyelitis than I ever thought that I would. Most of the cases were of the chronic type often with large involucrums that had to be removed surgically. It would have been very satisfying to have available all the antibiotics mentioned in your review, but all we had was cloxacillin and chloramphenocal, which have long ago disappeared from the armamentarium in the US. I only saw one case of MRSA in the five trips I made to Kenya.

If an investigator really wants to gain a great deal of experience in treating chronic osteomyelitis, and too some degree acute osteomyelitis, he/she should go to a facility such as Kijabe Medical Center or some other good hospital in a developing country. If the investigator could take along all the antibiotics available in the first world, I am sure that he/she could accomplish a great deal of good as well as learning a lot about a scourge that runs rampant in the developing countries.