title: Efficacy of a combined oral clindamycin?rifampicin regimen for therapy of staphylococcal osteoarticular infections.
abstract: A majority of osteoarticular and implant-related infections are due to staphylococci and biofilm formation. Combined therapy including rifampicin is frequently recommended. Indeed, rifampicin penetrates biofilms and kills adherent staphylococci, but cannot be administered as monotherapy because of the rapid emergence of resistant mutants. While several antibiotic combinations including rifampicin have been implemented, evaluation of the clindamycin-rifampicin combination has been neglected, presumably because of the emergence of alternative combinations, such as quinolone-rifampicin, and the fear of potential antagonistic interactions. We report a limited series of 20 patients (3 immune-suppressed) with 6 arthroplasty infections, 4 other implant infections, 7 native arthritis, and 3 osteomyelitis, who were all successfully treated with this oral combination for >75% of the antibiotic course (median duration 45 days). The excellent outcomes obtained with this antimicrobial combination after a mean follow-up of 2.6 y (range 1.0-6.1 y) warrant further clinical and microbiological studies for implementing this regimen in routine practice.
authors.affiliation: Orthopaedic Surgery Service, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Switzerland.
authors.forename: Jaroslaw
authors.initials: J
authors.lastname: Czekaj
authors.forename: Aurélien
authors.initials: A
authors.lastname: Dinh
authors.forename: Andreea
authors.initials: A
authors.lastname: Moldovan
authors.forename: Pierre
authors.initials: P
authors.lastname: Vaudaux
authors.forename: Guillaume
authors.initials: G
authors.lastname: Gras
authors.forename: Pierre
authors.initials: P
authors.lastname: Hoffmeyer
authors.forename: Daniel
authors.initials: D
authors.lastname: Lew
authors.forename: Louis
authors.initials: L
authors.lastname: Bernard
authors.forename: Ilker
authors.initials: I
authors.lastname: Uçkay
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002981:Clindamycin / Q000008:administration & dosage*; D004359:Drug Therapy, Combination / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000188:drug therapy* / Q000382:microbiology*; D016459:Prosthesis-Related Infections / Q000188:drug therapy / Q000382:microbiology; D012293:Rifampin / Q000008:administration & dosage*; D013203:Staphylococcal Infections / Q000188:drug therapy*; D013210:Staphylococcus / Q000187:drug effects; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D002981:Clindamycin; D012293:Rifampin