biostudies-literatureUnknown7(4)Gupta N<h4>Background</h4>Melioidosis, caused by <i>Burkholderia pseudomallei</i>, is a deadly infection with a case fatality rate of 10%-50%. Osteomyelitis, a rare manifestation, is particularly challenging due to diagnostic delays, misidentification, limited bone penetration of antibiotics and frequent relapses. Antibiotic intolerance emerges as a significant hurdle, with up to 26%-51% of patients developing severe allergies to trimethoprim/sulfamethoxazole, along with intolerability to ceftazidime and meropenem. These limitations demand innovative therapeutic approaches to combat this pathogen.<h4>Objectives</h4>To report a novel case of <i>B. pseudomallei</i>-induced radial osteomyelitis successfully managed with levonadifloxacin, a broad-spectrum benzoquinolizine antibiotic, after intolerancJAC-antimicrobial resistancedlaf122https://www.ebi.ac.uk/biostudies/studies/S-EPMC12238538biostudies-literatureNovel approach in treatment of &lt;i&gt;Burkholderia pseudomallei&lt;/i&gt; osteomyelitis: salvage therapy with levonadifloxacin.PMC12238538Gupta RAgashe VVidyarthi KSen IKoley MVeeraraghavan BGupta KGupta NSoman RfalseNovel approach in treatment of &lt;i&gt;Burkholderia pseudomallei&lt;/i&gt; osteomyelitis: salvage therapy with levonadifloxacin.<h4>Background</h4>Melioidosis, caused by <i>Burkholderia pseudomallei</i>, is a deadly infection with a case fatality rate of 10%-50%. Osteomyelitis, a rare manifestation, is particularly challenging due to diagnostic delays, misidentification, limited bone penetration of antibiotics and frequent relapses. Antibiotic intolerance emerges as a significant hurdle, with up to 26%-51% of patients developing severe allergies to trimethoprim/sulfamethoxazole, along with intolerability to ceftazidime and meropenem. These limitations demand innovative therapeutic approaches to combat this pathogen.<h4>Objectives</h4>To report a novel case of <i>B. pseudomallei</i>-induced radial osteomyelitis successfully managed with levonadifloxacin, a broad-spectrum benzoquinolizine antibiotic, after intoleranc2025-01-01T00:00:00Z2025 Aug2026-03-16T08:24:31.818Z2025-08-24T03:04:36.118ZS-EPMC122385384063639710.1093/jacamr/dlaf122