A comparison of early versus late conversion from intravenous to oral therapy in the treatment of septic arthritis.
BACKGROUND
Clinical outcomes of children with bacterial septic arthritis, common in the pediatric age group, are often satisfactory with early recognition, prompt surgical drainage, and appropriate antibiotic therapy. However, the optimal duration and route of antibiotic administration for treatment of septic arthritis continues to be debated, as traditional treatment favored longer intravenous (IV) therapies yet oral regimens are increasingly available that are more cost effective, safe and produce satisfactory disease resolution.


METHODS
Records of 186 patients from two children's hospitals, one that was thought to convert from IV to oral antibiotic therapy considerably earlier than the other, treated between 1985 and 1995 for bacterial septic arthritis were reviewed. Patients with concurrent osteomyelitis were excluded.


RESULTS
Patients at Hospital #1 were converted to oral antibiotics after 7.4+/-7.4 days of IV antibiotic therapy and at Hospital #2 after 18.6+/-13.6 (P<0.001) days of IV therapy. Both groups received an average of four weeks of total antibiotic treatment. There was similar time to defervescence (2.4+/-3.2 d vs. 2.4+/-3.8 d, P>0.05) and to normalization of erythrocyte sedimentation rate (35.7+/-19.7 d vs. 33.8+/-44.9 d, P>0.05) in the patients converted to oral therapy early compared to those converted late. One case of mild avascular necrosis with no clinical disability developed in a patient from Hospital #2.


CONCLUSIONS
We conclude that the clinical outcome in patients with septic arthritis converted to oral antibiotic therapy early in their treatment based on defined criteria was similar to those converted late.
Ballock
Robert Tracy
RT
Rady Children's Hospital, San Diego, California, USA.
Newton
Peter O
PO
Evans
Sean J
SJ
Estabrook
Michelle
M
Farnsworth
Christine L
CL
Bradley
John S
JS
D000284:Administration, Oral; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D001170:Arthritis, Infectious / Q000150:complications / Q000188:drug therapy*; D001799:Blood Sedimentation; D002648:Child; D002675:Child, Preschool; D005271:Femur Head Necrosis / Q000209:etiology; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007262:Infusions, Intravenous; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents