, Volume 22, Issue 10, pp 2346-2347
Date: 12 Sep 2013

Answer to the Letter to the Editor of Zafar Ahmad et al. concerning “Antibiotic treatment in patients with chronic low back pain and vertebral bone edema (Modic type 1 changes): a double-blind randomized controlled trial of efficacy” by Albert HB et al., Eur Spine J (2013) 22:697–707

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Thank you for your comments; we are happy that our papers have stimulated scientific discussions in the world of back science.

Your question as to which drug to use is a very important and crucial question. You find it, “odd that we used co-amoxiclav to treat the infection, when clavulanic acid has little disc penetration. Amoxicillin would have been more logical, as it has a narrower spectrum, and is known to be effective against Propionibacterium acnes, although it too has poor penetration of the intervertebral disc”

The answer is twofold. First, three independent international experts in infectious diseases were presented with the bacterial culture results of Stirling’s study [1] and all three recommended Amoxicillin-clavulanate. Second, we agree with you that clavulanic acid is most probably superfluous, but at the time of the planning of the study we were not able to obtain pure Amoxicillin. We therefore had no choice but to use co-amoxiclav.

In the question regarding penetration, ...