Abstract
Background/objective: Although several prospective trials have shown the efficacy of sequential intravenous followed by oral antimicrobial regimen in treatment of bone and joint infections, considerable uncertainty exists about ideal antibiotic regimen and optimal duration of antibiotic therapy.
The aim of this study was to demonstrate that short course antibiotic therapy combined with surgical drainage and followed by oral antibiotic therapy is quite adequate and suggested a scoring system as a comfortable and reliable tool to adjust the route of drug administration.
Methods: Thirty-three cases of acute hematogenous bone or joint infection were randomly treated with short term (7 days for joint infection, l0 days for bone infection) or a long-term (14 days and 21 days, respectively) intravenous antibiotics after surgical drainage. The treatment outcome was measured through a detailed scoring system that included the ability to eradicate infection, the functional status of the limb, and the radiological appearance of the bone and joint.
Criteria for discontinuation of parenteral antibiotic Scoring criteriapoints
Clinical evaluation
A: improved active motion of the joint: l
B: Painless active motion of the joint: 2
C: improvement in A & B:3
Radiological findings
A: progressive osteolysis ormultifocal involvement: 0
B: absence of the above findings*: 1
Laboratory evaluation
A: drop of 50.00/mm3 in WBC count or return to normal range (5.000–10.000 /mni3): 0.5
B: drop in ESR of 30 mm/hr or return to level of 30 mm/hr or less: 0.5
Total score: 5
*Pure periosteal elevation received a score of 1.
Patients with a score > or equal to 4 would be switched to oral antibiotic.
Results: The average follow up was 19 months. The scoring system had the following results: Infection was eradicated in both groups. Radiological scoring for septic arthritis was full for both groups and had a non-significant difference P> 0.05 between the 2 groups for osteomyelitis.
The mean functional scoring between the short-term group and long-term group were similar P> 0.05.
Overall, excellent or good results were achieved in both groups. No fair or poor results were observed. The average hospital cost for a patient in long-term group was twice that of a patient in short-term group.
Conclusion: It is concluded that for bone or joint infection in children who have received appropriate and early surgical treatment, intravenous antibiotics given for 7 days in joint infections and 10 days in bone infections, followed by 4 weeks of oral antibiotics, is an adequate treatment.
A decision on prolonging the duration of parenteral antibiotics should be based on a combination of clear clinical, laboratory, and radiographic criteria, such us the scoring system presented in this article.
The abstracts were prepared by editorial secretary, Mrs K. Papastefanou. Correspondence should be addressed to Professor K.N. Malizos, Department of Orthopaedic Surgery, School of Medicine, University of Thessalia, Larissa, 41222 GREECE
