Bone and joint infections caused by gram-positive bacteria: treatment with cefotaxime

Cefotaxime treatment was evaluated in 41 patients with serious bone and joint infections. Septic arthritis and bursitis (8), acute and chronic osteomyelitis (33) were treated with 3 to 12 g of cefotaxime per day for three to 52 days. The diagnosis of osteomyelitis or septic arthritis was made on the basis of clinical and roentgenographic evidence of infection. The diagnosis of a joint infection was confirmed by a positive culture of a joint aspirate sample. The diagnosis of a bone infection was confirmed by either a positive culture of a bone biopsy or of blood in combination with a positive bone scan or roentgenogram. Staphylococcus aureus was the most frequently isolated pathogen. Overall, 36 of 41 patients, who met all criteria for evaluation, had satisfactory responses to cefotaxime. The drug was well tolerated by all patients. However, six patients had a direct Coomb's test, two patients were noted to be neutropenic and two patients developed a macular rash. It is concluded that cefotaxime is a useful and safe antibiotic for the treatment of osteomyelitis and septic arthritis.