Dexamethasone Therapy for Septic Arthritis in Children

Abstract

BACKGROUND AND OBJECTIVE: Prospective studies of children with septic arthritis report that adding dexamethasone to antibiotic therapy contributes significantly to clinical and laboratory improvement. This study sought to evaluate the effect of this regimen outside of a randomized controlled trial. METHODS:The sample consisted of children with septic arthritis hospitalized at a tertiary pediatric medical center in 2008 to 2013. Disease course and outcome were compared between children treated with antibiotics alone or with adjuvant dexamethasone, according to the admitting department policy. RESULTS:The cohort included 116 patients, 90 treated with antibiotics alone and 26 treated with antibiotics+dexamethasone. The groups were similar for age, symptom duration before hospitalization, body temperature, acute-phase reactant levels, and rate of positive fluid cultures (21.6% total). Compared with monotherapy, antibiotics+dexamethasone treatment was associated with a shorter duration of fever (mean 2.3 vs 3.9 days, P = .002), more rapid clinical improvement (mean 6.3 vs 10.0 days to no pain/limitation, P , .001), more rapid decrease in C-reactive protein level to ,1 mg/dL (mean 5.3 vs 8.4 days, P = .002), shorter duration of parenteral antibiotic treatment (mean 7.1 vs 11.4 days, P , .001), and shorter hospital stay (mean 8.0 vs 10.7 days, P = .004). Recurrent symptoms of fever and joint pain occurred in 4 patients in the antibiotics+dexamethasone group after completion of the steroid course.CONCLUSIONS: Children with septic arthritis treated early with a short course of adjuvant dexamethasone show earlier improvement in clinical and laboratory parameters than children treated with antibiotics alone. WHAT'S KNOWN ON THIS SUBJECT:Two prospective studies of children with septic arthritis have shown that the addition of dexamethasone to antibiotic therapy contributes to clinical and laboratory improvement. Nevertheless, the mainstay of treatment remains antibiotics alone. WHAT THIS STUDY ADDS:This study, which was conducted outside a randomized controlled trial, demonstrates that children with septic arthritis treated early with a short course of adjuvant dexamethasone show earlier improvement in clinical and laboratory parameters than children treated with antibiotics alone.

Paediatric bone and joint infection

“…Recent studies suggested a potential beneficial role for intravenous steroid administration in children with septic arthritis. 56,57 The introduction of new generation cephalosporins and the use of monoclonal antibodies directed against virulence factors of the causative pathogen could affect outcomes in future. 3 …”

Septische Gonarthritis und ausgedehnter Wadenabszess durch Streptococcus intermedius bei einem 4-jährigen Jungen

“…Die SAG ist potenziell pyogen, wobei Streptococcus intermedius der pathogenste Keim der Gruppe ist. Er kann vor allem Abszess-Formationen in Hirn und Leber verursachen [2,4] und selten auch zu Endokarditis und Milzabszessen führen [4,5]. Typische Streptokokken-Virulenzfaktoren wie Hyaluronidase und Neuraminidase, die die Ausbreitung der Infektion begünstigen [2], wurden in Genomstudien identifiziert, funktionelle Studien der molekularen Basis fehlen jedoch [3].…”

“…1). [4]. Studien bei septischer Arthritis durch Streptococcus intermedius und DexamethasonTherapie liegen nicht vor.…”

AT-RvD1 combined with DEX is highly effective in treating TNF-α-mediated disruption of the salivary gland epithelium

“…DEX has been used to treat a broad range of inflammatory diseases, including Crohn's disease (Cully ), rheumatoid arthritis (Fogel et al. ), noninfectious uveitis (Tomkins‐Netzer et al. ), and asthma (Gries et al.…”

“…Consequently, they activate transcription factors that induce expression of anti-inflammatory genes (Vandevyver et al 2013). DEX has been used to treat a broad range of inflammatory diseases, including Crohn's disease (Cully 2015), rheumatoid arthritis (Fogel et al 2015), noninfectious uveitis (Tomkins-Netzer et al 2014), and asthma (Gries et al 2000), among other conditions. Alternatively, glucocorticoids cause repression of genes encoding proinflammatory mediators, including cytokines, chemokines, and inflammatory adhesion molecules (van der Velden 1998).…”