A B S T R A C TTreatment of bone and joint infections can be challenging as antibiotics should penetrate through the rigid bone structure and into the synovial space. Several pharmacokinetic studies measured the extent of penetration of different antibiotics into bone and joint tissues. This review discusses the results of these studies and compares them with minimum inhibitory concentrations (MIC) of common pathogens implicated in bone and joint infections in order to determine which antibiotics may have a greater potential in the treatment of such infections. Clinical outcomes were also evaluated as data were available. More than 30 antibiotics were evaluated. Overall, most antibiotics, including amoxicillin, piperacillin/tazobactam, cloxacillin, cephalosporins, carbapenems, aztreonam, aminoglycosides, fluoroquinolones, doxycycline, vancomycin, linezolid, daptomycin, clindamycin, trimethoprim/sulfamethoxazole, fosfomycin, rifampin, dalbavancin, and oritavancin, showed good penetration into bone and joint tissues reaching concentrations exceeding the MIC 90 and/or MIC breakpoints of common bone and joint infections pathogens. Few exceptions include penicillin and metronidazole which showed a lower than optimum penetration into bones, and the latter as well as flucloxacillin had poor profiles in terms of joint space penetration. Of note, studies on joint space penetration were fewer than studies on bone tissue penetration. Although clinical studies in osteomyelitis and septic arthritis are not available for all of the evaluated antibiotics, these pharmacokinetic results indicate that agents with good penetration profiles would have a potential utilization in such infections.

Introduction: Brucellosis is a zoonotic disease caused by Brucella spp. affecting multiple body systems and may lead to complications. Saudi Arabia is a country where brucellosis is endemic. This study aimed to describe the epidemiological characteristics of uncomplicated brucellosis and to assess outcomes of different antibiotic regimens. Methodology: A retrospective cohort study in a Saudi tertiary academic medical center. Adults with confirmed uncomplicated brucellosis between January 2008 and December 2018 who received antibiotics were included. The primary endpoint was clinical cure. Secondary endpoints included all-cause mortality and length of stay. Results: Fifty-four patients met the inclusion criteria and were included in the study. Twenty five patients received a combination of doxycycline, rifampin, and aminoglycoside (group 1), whereas 29 patients received doxycycline and rifampin (group 2). There was no significant difference between the two groups in clinical cure, all-cause mortality, length of stay, and end of therapy parameters, including temperature, white blood cells count, C-reactive protein levels, and erythrocyte sedimentation rates. Conclusions: Due to lack of differences in clinical outcomes, mortality, length of stay, and end of therapy parameters between the two groups, a regimen comprising two, rather than three, agents can be sufficient for uncomplicated brucellosis. This finding conforms to previous studies. Therefore, replacing rifampin with an aminoglycoside for its presumed superior efficacy as per the World Health Organization's guidelines is not substantiated by our study. Further studies with a larger sample size are required to confirm these findings.

BackgroundBrucellosis is a zoonotic infectious disease caused by Brucella spp. that affects multiple body systems and may lead to several complications. Saudi Arabia is one of the countries where brucellosis is endemic. The purpose of this study was to describe the epidemiological characteristics of brucellosis as well as assessing outcomes of different antibiotic regimens.MethodsA retrospective cohort study was conducted in a Saudi tertiary academic medical center. Eligible patients were adults with confirmed brucellosis (via culture, antibody test, or both) seen between January 2008 and March 2018 who received antibiotic therapy. Endpoints included clinical cure, all-cause mortality, and length of stay (LOS). Data were analyzed using ANOVA and chi-square. A P-value of < 0.05 was considered statistically significant.ResultsOut of 580 patients screened, 79 met the criteria and were included in the study. Based on the most common regimens prescribed, patients were divided into three groups, doxycycline–rifampin–aminoglycoside (DRA) with 39 patients, doxycycline–rifampin (DR) with 28 patients, and other regimens with 12 patients. All groups did not differ in their baseline characteristics except for the location (mostly outpatients or inpatients and very few in the intensive care unit), duration of therapy, and the presence of co-infection (most patients did not have co-infections). The most common risk factor was consumption of raw dairy products and most patients had both B. melitensis and B abortus in their culture and/or antibody test. There was no significant difference between the groups in terms of clinical cure, all-cause mortality, LOS, and end of therapy temperature, white blood cells counts, C-reactive protein levels, and erythrocyte sedimentation rates.ConclusionDue to lack of differences in clinical outcomes, all-cause mortality, LOS, and end of therapy parameters between the three groups, a regimen comprising two, rather than three, agents (namely doxycycline and rifampin) can be sufficient. Such finding complies with previous studies although replacing rifampin with an aminoglycoside might be superior per the World Health Organization guidelines for the treatment of brucellosis. Further studies with a larger sample size are warranted to confirm these findings.Disclosures All authors: No reported disclosures.