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A Comparison of Early Versus Late Conversion From Intravenous to Oral Therapy in the Treatment of Septic Arthritis

Ballock, Robert Tracy MD*; Newton, Peter O. MD† ‡; Evans, Sean J. MD; Estabrook, Michelle MD§; Farnsworth, Christine L. MS; Bradley, John S. MD† ‡

Journal of Pediatric Orthopaedics: September 2009 - Volume 29 - Issue 6 - p 636-642
doi: 10.1097/BPO.0b013e3181b2b860
Selected Topics

Background Clinical outcomes of children with bacterial septic arthritis, common in the pediatric age group, are often satisfactory with early recognition, prompt surgical drainage, and appropriate antibiotic therapy. However, the optimal duration and route of antibiotic administration for treatment of septic arthritis continues to be debated, as traditional treatment favored longer intravenous (IV) therapies yet oral regimens are increasingly available that are more cost effective, safe and produce satisfactory disease resolution.

Methods Records of 186 patients from two children's hospitals, one that was thought to convert from IV to oral antibiotic therapy considerably earlier than the other, treated between 1985 and 1995 for bacterial septic arthritis were reviewed. Patients with concurrent osteomyelitis were excluded.

Results Patients at Hospital ♯1 were converted to oral antibiotics after 7.4±7.4 days of IV antibiotic therapy and at Hospital ♯2 after 18.6±13.6 (P<0.001) days of IV therapy. Both groups received an average of four weeks of total antibiotic treatment. There was similar time to defervescence (2.4±3.2 d vs. 2.4±3.8 d, P>0.05) and to normalization of erythrocyte sedimentation rate (35.7±19.7 d vs. 33.8±44.9 d, P>0.05) in the patients converted to oral therapy early compared to those converted late. One case of mild avascular necrosis with no clinical disability developed in a patient from Hospital ♯2.

Conclusions We conclude that the clinical outcome in patients with septic arthritis converted to oral antibiotic therapy early in their treatment based on defined criteria was similar to those converted late.

*Cleveland Clinic, Cleveland, Ohio

Rady Children's Hospital, San Diego, California

University of California, San Diego

§Washington University, St. Louis, MO

Reprints: Robeert Tracy Ballock, MD, Department of Orthopaedic Surgery, A-41, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195. E-mail:

Study conducted at: Rady Children's Hospital, San Diego, California, USA.

Rainbow Babies & Children's Hospital, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio, USA.

These data were previously published in part: Peter O. Newton, R. Tracy Ballock and John S. Bradley. Oral Antibiotic Therapy of Bacterial Arthritis. Concise Reviews of Pediatric Infectious Disease, December 1999, p. 1102-1103.

© 2009 Lippincott Williams & Wilkins, Inc.