Double blind, randomized, placebo-controlled study of dexamethasone therapy for hematogenous septic arthritis in children

Odio, Carla; Ramirez, Tobias; Arias, Gloria A. González; Abdelnour, Arturo; Hidalgo, Isabel; Herrera, Marco Luis; Bolaños, Willy; Alpízar, Jorge; Alvarez, Patricio

doi:10.1097/01.inf.0000091293.32187.7b

Cited by 127 publications

(68 citation statements)

References 13 publications

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“…K kingae infection was also one of the most common causes of childhood septic arthritis in several previous studies 17,18 and the earlier study from our center. 11 By contrast, Odio et al 10 found S aureus to be the most common pathogen. Because penetrance of antibiotics into the joint fluid was not directly evaluated in our study, we could not determine if it was affected by the corticosteroids.…”

Section: Discussionmentioning

confidence: 99%

“…[10][11][12] The results showed that a 4-day course of adjuvant dexamethasone shortened the duration of symptoms and hospital stay and reduced residual dysfunction at the end of therapy. The rationale for the dosing schedule was derived from the Haemophilus influenzae B meningitis protocol 13 ; the use of corticosteroids was prompted by findings of a decrease in synovial T-cell and macrophage levels in animals with septic arthritis treated with dexamethasone and antibiotics.…”

Section: Discussionmentioning

confidence: 99%

“…5,9 These results were supported by 2 clinical studies in children. The first, by Odio et al, 10 showed that a short course of dexamethasone significantly shortened the duration of symptoms and reduced residual joint dysfunction. The second study was conducted by our group in 49 patients using a randomized doubleblind placebo-controlled design.…”

Section: What This Study Addsmentioning

confidence: 99%

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Dexamethasone Therapy for Septic Arthritis in Children

Fogel¹,

Amir²,

Bar‐On³

et al. 2015

PEDIATRICS

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: What This Study Addsmentioning

confidence: 99%

See 1 more Smart Citation

Dexamethasone Therapy for Septic Arthritis in Children

Fogel¹,

Amir²,

Bar‐On³

et al. 2015

PEDIATRICS

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“…Septic arthritis continues to be an entity with worrying figures on morbidity and mortality, with scarce information from Latin-American countries [3,4]. The high concurrency of osteomyelitis observed in this series is not surprising [5].…”

Section: Discussionmentioning

confidence: 82%

Clinical and microbiological features of septic arthritis in children: Experience of one Latin American country

Sanabria¹,

Delgado

Arbo

2018

J Infect Dev Ctries

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“…On the other hand, it is well known that severity of infection is related to the extent of the inflammatory response of the immune system [2][3][4]. Treatment for bacterial infections with antimicrobials in combination with anti-inflammatory drugs, such as corticosteroids, has been proven to be effective and safe in several randomized controlled trials (RCTs) in patients with bacterial and tuberculous meningitis [5,6], tuberculous pericarditis [7], septic arthritis [8] and septic shock [9]. Furthermore, it has become clear that the beneficial effects of macrolide antibiotics are antiinflammatory in addition to being antibacterial in nature [10].…”

Section: Introductionmentioning

confidence: 99%