title: Dexamethasone therapy for septic arthritis in children: results of a randomized double-blind placebo-controlled study.
abstract: BACKGROUND
  We evaluated the effect of adding dexamethasone to antibiotic therapy in the clinical course of septic arthritis in children.
  
  
  METHODS
  A randomized double-blind placebo-controlled trial was performed. The study group included 49 children with septicarthritis. In addition to antibiotic therapy given, patients were randomly assigned to receive intravenous dexamethasone 0.15 mg/kg every 6 hours for 4 days or placebo. The groups were compared for clinical and laboratory parameters, length of hospital stay, and late sequelae.
  
  
  RESULTS
  Mean age was 33±42 months (range: 6 to 161 mo). There was no significant difference between the dexamethasone and placebo groups in age, duration of symptoms, joint affected, or levels of acute phase reactants. Bacteria were isolated from joint fluid in 17 patients (35%) and from blood in 4 patients. Compared with the placebo group, patients treated with dexamethasone had a significantly shorter duration of fever (P=0.021; mean first day without fever 1.68 vs 2.83) and local inflammatory signs (P=0.021; mean first day without pain 7.18 vs 10.76), lower levels of acute phase reactants (P=0.003; mean last day of erythrocyte sedimentation rate>25 mm/h 3.76 vs 8.40), shorter duration of parenteral antibiotic treatment (P=0.007; mean of 9.91 d vs 12.60 d), and shorter hospital stay. No side effects of treatment were recorded in either group.
  
  
  CONCLUSIONS
  A 4-day course of dexamethasone given at the start of antibiotic treatment in children with septic arthritis, is safe, and leads to a significantly more rapid clinical improvement, shortening duration of hospitalization compared with those treated with antibiotics alone.
  
  
  METHODS
  I.
authors.affiliation: Department of Pediatrics C, Schneider Children’s Medical Center of Israel, Petach Tikvah 49202, USA. liorahar@clalit.org.il
authors.forename: Liora
authors.initials: L
authors.lastname: Harel
authors.forename: Dario
authors.initials: D
authors.lastname: Prais
authors.forename: Elhanan
authors.initials: E
authors.lastname: Bar-On
authors.forename: Gilat
authors.initials: G
authors.lastname: Livni
authors.forename: Vered
authors.initials: V
authors.lastname: Hoffer
authors.forename: Yosef
authors.initials: Y
authors.lastname: Uziel
authors.forename: Jacob
authors.initials: J
authors.lastname: Amir
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001170:Arthritis, Infectious / Q000188:drug therapy* / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D003907:Dexamethasone / Q000009:adverse effects / Q000627:therapeutic use*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005938:Glucocorticoids / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D007902:Length of Stay; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D005938:Glucocorticoids; D003907:Dexamethasone