Cefuroxime in acute septic arthritis

Cefuroxime was used in 17 patients with clinical, bacteriological and/or laboratory signs of acute septic arthritis in comparison with 10 patients given cloxacillin and ampicillin alone, or in combination. 14 patients in the study group had positive cultures (Staphylococcus aureus, 10, S. epidermidis, 1, Streptococcus pyogenes group G, 2 and Acinetobacter, 1). Three more patients with non-bacterial arthritis were included in an antibiotic penetration study. In 6 patients serum and joint fluid concentrations of cefuroxime were repeatedly determined by an assay using high pressure liquid chromatography. After 1.5 g intravenous cefuroxime the joint fluid concentrations were 16-80 and 5-40 mg/l at 2 and 8 h, respectively, exceeding the serum concentrations during that period of time. From the clinical and pharmacokinetic data a dosage of 1.5 g cefuroxime intravenously t.i.d. is recommended to the adult patient. This high dosage resulted in primary healing in 11 patients with one relapse one year later in a patient with a knee arthroplasty. Half the dosage intramuscularly in 6 patients failed in 2. No side effects were seen during cefuroxime therapy.