Dexamethasone Therapy + Antibiotics for Septic Arthritis in Children

Abstract

Research Article| June 01 2011 Dexamethasone Therapy + Antibiotics for Septic Arthritis in Children AAP Grand Rounds (2011) 25 (6): 64. https://doi.org/10.1542/gr.25-6-64 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Dexamethasone Therapy + Antibiotics for Septic Arthritis in Children. AAP Grand Rounds June 2011; 25 (6): 64. https://doi.org/10.1542/gr.25-6-64 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search nav search search input Search input auto suggest search filter All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: bacterial arthritis, dexamethasone Source: Harel L, Prais D, Bar-on E, et al. Dexamethasone therapy for septic arthritis in children: results of a randomized doubleblind placebo-controlled study. J Pediatr Orthop. 2011; 31(2): 211– 215; doi: https://doi.org/10.1097/BPO.0b013e3182092869Google Scholar Investigators from Israel designed this prospective, randomized, double-blind, placebo-controlled study to determine if a four-day course of dexamethasone given at the start of antibiotic treatment in children with septic arthritis is safe, and leads to a more rapid clinical improvement compared to children treated with antibiotics alone. Children with septic arthritis who met the inclusion criteria of 1) an acute swollen, painful, warm joint with limited motion; 2) aspirated joint fluid containing more than 50,000 white blood cells/ mm3; and 3) elevated acute phase reactants, were enrolled. Intravenous cefuroxime 150 mg/kg/dose in three divided doses was initiated in all patients. Study patients were randomized to receive IV dexamethasone, 0.15mg/kg/dose every 6 hours for 16 consecutive doses, or placebo. The primary endpoints of the study were time to clinical and laboratory normalization and duration of hospitalization. The secondary endpoint was evidence of late sequelae. A total of 49 children were enrolled in the study; 25 were randomized to receive dexamethasone and 24 received placebo. The mean patient age was 33 months (range 6–161). The affected joints included hips (21), knees (18), ankles (5), elbows (3), and shoulders (2). There were no significant differences between the two groups in age, duration of symptoms, joint affected, or initial level of acute phase reactants. Bacteria were cultured from the joint fluid in 17 patients (35%) and from the blood in 4 patients (8%). The most common organisms isolated were Kingella kingae in seven patients (41%) and methicillin-sensitive Staphylococcus aureus in three cases (18%). Compared to the placebo group, patients treated with dexamethasone had a significantly earlier mean first day without fever (1.7 vs 2.8 days, P=.021), mean first day without pain (7.2 vs 10.8 days, P=.021), mean first day of full range of motion (7.0 vs 12.2 days, P=.03), faster return of ESR to less than 25 mm/h (3.8 vs 8.4 days, P=.003), faster return of CRP to less than 0.5 mg/dL (3.1 vs 5.5 days, P=.029), shorter duration of IV treatment (9.9 vs 12.6 days, P=.007), and shorter hospital stay. Duration of follow-up ranged from 2 to 12 months and there were no adverse outcomes such as limitation in range of motion or leg length discrepancies. The authors conclude that dexamethasone given during the first four days of antibiotic treatment of children with septic arthritis is safe and leads to more rapid clinical improvement. Dr Hennrikus has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. This is a spectacular study that may change pediatric practice. In this well-designed study, a four-day course of dexamethasone given to children with septic arthritis was safe, resulted in... You do not currently have access to this content.