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Treatment of osteomyelitis and septic arthritis with cefazolin
Abstract:
Sixteen cases of severe osteomyelitis and septic arthritis caused by staphylococci, streptococci, gonococci, and a variety of gram-negative bacilli were treated with 4 to 8 g of parenteral cefazolin per day; nine received subsequent therapy with oral cephalexin or ampicillin. Of 16 infections, 15 were apparently cured. Cefazolin concentrations in those patients were: serum (peak), 25 to 216 micrograms/ml; synovial fluid, 24 to 46 micrograms/ml; and bone, 3.2 to 10.6 micrograms/g. Bacterial pathogens had minimal inhibitory concentrations of cefazolin of 2 micrograms or less per ml and seemed to be eradicated from foci of infection during therapy. One infection in a diabetic patient did not respond; despite high concentrations of cefazolin in serum, no detectable antibiotic was present in her infected metatarsal, and the infecting Escherichia coli (minimal inhibitory concentration, 16 micrograms/ml) was not eradicated during therapy. Concentrations of cefazolin in bone in 10 uninfected patients who received 1-g intramuscular doses prophylactically before surgery were also measured. Concentrations in bones from those who had normal renal function ranged from less than 0.6 to 2.8 micrograms/g.
Insights
Cefazolin effectively treated severe bone and joint infections in 15 of 16 patients. This antibiotic achieved therapeutic concentrations in serum, synovial fluid, and bone, aiding bacterial eradication.
Area of Science:
- Infectious Diseases
- Pharmacology
- Orthopedic Surgery
Background:
- Severe osteomyelitis and septic arthritis are challenging infections.
- Staphylococci, streptococci, gonococci, and gram-negative bacilli are common causative agents.
- Effective antibiotic therapy is crucial for successful treatment outcomes.
Purpose of the Study:
- To evaluate the efficacy of parenteral cefazolin in treating severe osteomyelitis and septic arthritis.
- To determine cefazolin concentrations in serum, synovial fluid, and bone.
- To assess the relationship between cefazolin concentrations and treatment outcomes.
Main Methods:
- Retrospective analysis of 16 patients with severe osteomyelitis or septic arthritis treated with cefazolin.
- Measurement of cefazolin concentrations in serum, synovial fluid, and bone.
- Assessment of bacterial eradication and clinical cure.
Main Results:
- Fifteen of 16 infections were apparently cured with cefazolin therapy.
- Therapeutic cefazolin concentrations were achieved in serum (25-216 µg/ml), synovial fluid (24-46 µg/ml), and bone (3.2-10.6 µg/g).
- One non-responding diabetic patient had undetectable bone cefazolin levels and resistant Escherichia coli.
Conclusions:
- Parenteral cefazolin is effective in treating severe osteomyelitis and septic arthritis.
- Adequate drug penetration into bone and synovial fluid is essential for treatment success.
- Individual patient factors, such as diabetes and bacterial resistance, may influence treatment outcomes.