Efficacy of empirically prescribed amoxicillin and amoxicillin + clavulanic acid in children's reactive arthritis: a randomised trial.
OBJECTIVE
To evaluate the efficacy of early empiric prescription of amoxicillin and amoxicillin + clavulanic acid in children with reactive arthritis (ReA) when the arthritis-triggering microorganism is not identified.


METHODS
138 children, ranging in age from 2 to 16 years, with ReA of up to 3 months duration were randomly assigned to 3 groups and either prescribed antibacterial treatment with amoxicillin or amoxicillin + clavulanic acid (amoxicillin-potassium clavulanate combination) or were not given antibiotics (control group). Patients in all 3 groups were prescribed the usual treatment with nonsteroidal antiinflammatory drugs. Both groups of patients under antibacterial treatment were randomised into 2 subgroups: patients given a 10- to 14-day or a 28-day-duration antibacterial course. The results of the study were evaluated after 1 and 3 months of observation by determining the percentage of patients that had no clinical or laboratory signs of disease activity.


RESULTS
After 1 month of observation no signs of disease activity were found in 48.0% of patients who were prescribed amoxicillin, in 58.5% of patients treated with amoxicillin + clavulanic acid, and only in 13.0% of patients from the control group (p < 0.001 for either antibacterial treatment in comparison with the control group). After 3 months of observation no disease activity was found in 92.0% of patients who used amoxicillin, in 95.1% of those treated with amoxicillin + clavulanic acid, and in 58.7% of children from the control group (p < 0.001 for either antibacterial treatment in comparison with the control group). There was no significant difference in the efficacy of amoxicillin and amoxicillin + clavulanic acid. The duration of the antibacterial course showed no influence on the results of treatment.


CONCLUSIONS
Amoxicillin or amoxicillin + clavulanic acid in 10- to 14-day courses are advisable, in addition to the antirheumatic treatment, for children in the early stage of ReA when the arthritis-triggering microorganism is not identified.
Astrauskiene
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Department of Rheumatology, Institute of Experimental and Clinical Medicine, Vilnius University, Vilnius, Lithuania. astrauskd@mail.lt
D000293:Adolescent; D000658:Amoxicillin / Q000008:administration & dosage*; D019980:Amoxicillin-Potassium Clavulanate Combination / Q000008:administration & dosage*; D016918:Arthritis, Reactive / Q000175:diagnosis* / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010147:Pain Measurement; D011336:Probability; D000091402:Prohibitins; D016059:Range of Motion, Articular / Q000502:physiology; D012016:Reference Values; D012720:Severity of Illness Index; D016896:Treatment Outcome
C000717331:PHB2 protein, human; D000091402:Prohibitins; D019980:Amoxicillin-Potassium Clavulanate Combination; D000658:Amoxicillin