Advertisement

Clinical Pharmacokinetics

, Volume 31, Issue 2, pp 156–163 | Cite as

Pharmacokinetic Optimisation of the Treatment of Septic Arthritis

  • Kamal A. Homed
  • Janice Y. Tam
  • Charles G. Prober
Review Article Disease Management

Summary

Early diagnosis and treatment of septic arthritis improves the potential for a favourable outcome. Optimal treatment includes the prompt and judicious use of effective antimicrobial agents coupled with prompt drainage of the affected joint. Adequate drainage may be accomplished by means of repeated closed large-bore needle aspiration, arthroscopy, or an open surgical procedure.

The purpose of this article is to describe optimal antimicrobial therapy based upon available pharmacokinetic data. The host-dependent vulnerability to specific pathogens, local antibacterial susceptibility patterns and knowledge of antibacterial activity at the site of infection must all be taken into account when planning appropriate treatment. This article does not address arthritis secondary to human and animal bites, diabetic foot infections, mycobacteria, fungi, Lyme spirochaete, or other nonbacterial causes of septic arthritis.

Keywords

Synovial Fluid Cefotaxime Cefuroxime Septic Arthritis Aztreonam 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Prober CG. Current antibiotic therapy of community-acquired bacterial infections in hospitalized children: bone and joint infections. Pediatr Infect Dis J 1992; 11: 156–9PubMedCrossRefGoogle Scholar
  2. 2.
    Wilber RB. Beta-lactam therapy of osteomyelitis and septic arthritis. Scand J Infect Dis 1984; 42: 155–68Google Scholar
  3. 3.
    Brause BD. Infections associated with prosthetic joints. Clin Rheum Dis 1986; 12: 523–36PubMedGoogle Scholar
  4. 4.
    Smith JW, Piercy EA. Infectious arthritis. Clin Infect Dis J 1995; 20: 225–31CrossRefGoogle Scholar
  5. 5.
    Dorff GJ, Ziokowski JS, Rytel MW. Detection by counterimmunoelectrophoresis of pneumococcal antigen in synovial fluid from septic arthritis. Arthritis Rheum 1975; 18: 613–5CrossRefGoogle Scholar
  6. 6.
    Tuazon CU. Teichoic acid antibodies in osteomyelitis and septic arthritis caused by Staphylococcus aureus. J Bone Joint Surg 1982; 64A; 762–5Google Scholar
  7. 7.
    Nelson JD. Antibiotic concentrations in septic joint effusions. N Engl J Med 1971; 284: 349–53PubMedCrossRefGoogle Scholar
  8. 8.
    Parker RH, Schmid FR. Antibacterial activity of synovial fluid during therapy of septic arthritis. Arthritis Rheum 1971; 14: 96–104PubMedCrossRefGoogle Scholar
  9. 9.
    Tetzlaff TR, Howard JB, McCracken GH, et al. Antibiotic concentrations in pus and bone of children with osteomyelitis. J Pediatr 1978; 92: 135–40PubMedCrossRefGoogle Scholar
  10. 10.
    Nelson JD, Howard JB, Shelton S. Oral antibiotic therapy for skeletal infections of children. J Pediatr 1978; 92: 131–4PubMedCrossRefGoogle Scholar
  11. 11.
    Howell A, Sutherland R, Rolinson GN. Effect of protein binding on levels of ampicillin and cloxacillin in synovial fluid. Clin Pharmacol Ther 1972; 13: 724–32PubMedGoogle Scholar
  12. 12.
    Viek P. Concentration of sodium nafcillin in pathological synovial fluid. Antimicrob Agents Chemother 1962; 379–83Google Scholar
  13. 13.
    Baciocco EA, Iles RL. Ampicillin and kanamycin concentrations in joint fluid. Clin Pharmacol Ther 1971; 12: 858–63PubMedGoogle Scholar
  14. 14.
    Schurman DJ, Hirshman HP, Kajiyama G, et al. Cefazolin concentrations in bone and synovial fluid. J Bone Joint Surg 1978; 60-A: 359–62Google Scholar
  15. 15.
    Valencia-Chinas A, Galindo-Hernandez F, Reyes-Sanchez J, et al. Concentrations of cefadroxil in osteoarticular tissues [abstract no. 338]. Abstracts of the 19th Interscience Conference on Antimicrobial Agents and Chemotherapy; American Society for Microbiology; 1979: Washington, DC.Google Scholar
  16. 16.
    Vainiopää S, Wilppula E, Lalla M, et al. Cefamandole and isoxazolyl penicillins in antibiotic prophylaxis of patients undergoing total hip or knee-joint arthroplasty. Arch Orthop Trauma Surg 1988; 107: 228–30CrossRefGoogle Scholar
  17. 17.
    Harle A, Ritzerfeld W, Kluppelberg FH. Cefotaxime levels in synovial fluid following intravenous administration. Z Orthop Ihre Grenzgeb 1988; 126: 425–30PubMedCrossRefGoogle Scholar
  18. 18.
    Morgan JR, Pauli A, O'Sullivan M, et al. The penetration of ceftriaxone into synovial fluid of the inflamed joint. J Antimicrob Chemother 1985; 16: 367–71PubMedCrossRefGoogle Scholar
  19. 19.
    Somekh E, Heifets L, Tanai A, et al. Penetration of cefixime into synovial fluid [abstract A56]. 35th Interscience Conference on Antimicrobial Agents and Chemotherapy: 1995 Sep 17; Washington, DC: 11Google Scholar
  20. 20.
    MacLeod CM, Bartley EA, Galante JO, et al. Aztreonam penetration into synovial fluid and bone. Antimicrob Agents Chemother 1986; 29: 710–2PubMedCrossRefGoogle Scholar
  21. 21.
    Bosseray A, Leclercq P, Manquat G, et al. Penetration of ciprofloxacin into synovial fluid after oral dosing. J Antimicrob Chemother 1992; 30: 874–5PubMedCrossRefGoogle Scholar
  22. 22.
    Dee TH, Kozin F. Gentamicin and tobramycin penetration into synovial fluid. Antimicrob Agents Chemother 1977; 12: 548–9PubMedCrossRefGoogle Scholar
  23. 23.
    Geraci JE, Heilman ER, Nichols DR, et al. Some laboratory and clinical experiences with a new antibiotic, vancomycin. Proc Staff Meetings Mayo Clin 1956; 31: 564–82Google Scholar
  24. 24.
    Gerding DN, Peterson LR, Hughes CE, et al. Extravascular antimicrobial distribution and the respective blood-concentrations in humans. In: Lorian V, editor. Antibiotics in laboratory medicine. 3rd ed. Baltimore: Williams & Wilkins, 1991Google Scholar
  25. 25.
    Drutz DJ, Schaffner W, Hillman JW, et al. The penetration of penicillin and other antimicrobials into joint fluid. J Bone Joint Surg 1967; 49-A: 1415–21Google Scholar
  26. 26.
    Hedström SÅ, Lindgren L, Nilsson-Ehle I. Cefuroxime in acute septic arthritis. Scand J Infect Dis 1984; 16: 79–82PubMedCrossRefGoogle Scholar
  27. 27.
    Parker RH, Birbara C, Schmid FR. Passage of nafcillin and ampicillin into synovial fluid. In: Jeljaszewicz J, editor. Staphylococci and staphylococcal diseases. New York: Gustav Fischer Verlag, 1976: 1115–23Google Scholar
  28. 28.
    Sutherland R, Croydon EA, Rolinson GN. Flucloxacillin, a new isoxazolyl penicillin, compared with oxacillin, cloxacillin, and dicloxacillin. BMJ 1970; 4: 455–60PubMedCrossRefGoogle Scholar
  29. 29.
    Black J, Hunt TL, Godley PJ, et al. Oral antimicrobial therapy for adults with osteomyelitis or septic arthritis. J Infect Dis 1987; 155: 968–72PubMedCrossRefGoogle Scholar
  30. 30.
    Kolyvas E, Ahronheim G, Marks MI, et al. Oral antibiotic therapy of skeletal infections in children. Pediatrics 1980; 65: 867–71PubMedGoogle Scholar
  31. 31.
    Nelson JD, Bucholz RW, Kusmiesz H, et al. Benefits and risks of sequential parenteral-oral cephalosporin therapy for suppurative bone and joint infections. J Pediatr Orthop 1982; 2: 255–62PubMedCrossRefGoogle Scholar
  32. 32.
    Prober CG. Oral antibiotic therapy for bone and joint infections. Pediatr Infect Dis J 1982; 1: 8–10CrossRefGoogle Scholar

Copyright information

© Adis International Limited 1996

Authors and Affiliations

  • Kamal A. Homed
    • 1
  • Janice Y. Tam
    • 1
  • Charles G. Prober
    • 2
  1. 1.Department of MedicineStanford University School of Medicine, Stanford University Medical CenterStanfordUSA
  2. 2.Division of Infectious Diseases, Department of PediatricsStanford University School of Medicine, Stanford University Medical CenterStanfordUSA

Personalised recommendations