Gram negative bone and joint infection: sixty patients treated with amikacin

Sixty patients with bone and joint infections secondary to gram negative infection were evaluated in relation to treatment with amikacin. Forty-seven of these patients had osteomyelitis, and 13 had joint infections, including 3 prosthetic replacements. The patients' average was 35 years and there was no predilection for any particular skeletal location. Only 6 patients had no associated predisposing medical problems. Of these problems fracture, diabetes and narcotic abuse were most common. Thirty patients had Psuedomonas infection, and 15 others had multiple pathogens including Pseudomonas. Aminoglycoside antibiotics had been previously used in 25. Amikacin was given for an average of 22 days with a mean dose of 13.4 mg/kg. Bone and synovial fluid levels of amikacin were in therapeutic range. At least 48 patients had concurrent local wound treatment in addition to parenteral administration of amikacin. In 47 patients enough information was available to determine the efficacy of treatment. Twenty-seven (57%) of these patients were considered cured, both clinically and for bacteriologic response; and additional 9 (19%) were considered partially cured. Amikacin is effective against susceptible pathogens in bone and joint infections and is a reasonable choice when aminoglycoside antibiotic is indicated.