Efficacy of cotrimoxazole (Sulfamethoxazole-Trimethoprim) as a salvage therapy for the treatment of bone and joint infections (BJIs)

Abstract

IntroductionCotrimoxazole (Sulfamethoxazole-Trimethoprim, SXT) has interesting characteristics for the treatment of bone and joint infection (BJI): a broad spectrum of activity with adequate bone diffusion and oral and intravenous formulations. However, its efficacy and safety in BJIs are poorly documented and its use remains limited.MethodsWe conducted a retrospective study in 2 reference centers for BJIs from 2013 to 2018 among patients treated with SXT for a BJI. Data were collected from patient’s medical charts. Outcomes and adverse events were evaluated at day (D)7, D45 and D90.ResultsWe analyzed 51 patients with a mean age of 60 ± 20 (SD) years of which 76% presented with an orthopedic device infection (ODI). Gram-negative bacilli (GNB) were involved in 47% of BJIs (n = 24). Moreover, they were often polymicrobial infections (41%). Doses of SXT ranged from 800/160mg bid (61%; n = 31) to 800/160mg tid (39%; n = 20). Median SXT treatment duration was 45 days (IQR 40–45). SXT was part of a dual therapy in 84% of patients (n = 43), associated mainly with fluoroquinolones (n = 17) or rifampicin (n = 14). Outcome was favorable at D7 in 98% (n = 50), at D45 in 88.2% (n = 45) and at D90 in 78.4% (n = 40). The second agent combined with SXT was not an independent factor of favorable outcome (p = 0.97). Adverse events were reported in 8% (n = 4) of patients, with a median of 21 days (IQR 20–30) from SXT initiation and led to discontinuation (n = 3).ConclusionSXT appears to be effective for treatment of BJIs as a salvage therapy, even in GNB or polymicrobial infection, including ODI. Further data are needed to confirm SXT efficacy as an alternative oral regimen in BJIs.

Update on Acute Bone and Joint Infections in Paediatrics: A Narrative Review on the Most Recent Evidence-Based Recommendations and Appropriate Antinfective Therapy

“…Trials conducted by Peltola et al showed a failure rate under 1% at follow-up [ 64 ]. Trimethoprim/sulfamethoxazole (TMP/SMX) has been successfully used in oral treatment of BJI in children [ 72 , 73 , 74 ]. The duration of oral therapy in uncomplicated BJIs is frequently approximately 3–4 weeks with rigorous monitoring of inflammatory markers and drug tolerability [ 32 ].…”

Differential microbiological spectrum and resistance pattern in periprosthetic hip joint infections: a matched-cohort analysis comparing direct anterior versus lateral approach

“…Resistance rate analysis further identified Cotrimoxazol, Daptomycin, Fosfomycin, and Linezolid as antibiotics with relatively low resistance rates in cases with Staphylococcus epidermidis and Staphylococcus aureus . In fact, Cotrimoxazol has been demonstrated to be an effective antibiotic, which can be used as a salvage therapy in bone and joint infections, even in the setting of infections with gram-negative bacilli, polymicrobial infection, and orthopedic device infections [ 26 ]. Our data underline the important role of Cotrimoxazol (Sulfamethoxazole-Trimethoprim, SXT) in the treatment of aggressive periprosthetic joint infections with low resistance rates.…”

Antibiotic Therapy for Prosthetic Joint Infections: An Overview

“…When fluroquinolones cannot be used because of resistance or drug AEs, co-trimoxazole is an oral alternative. It is usually prescribed in combination, but robust data on its efficacy are limited [105]. We treat that setting with at least 4 weeks of ceftriaxone before switching to oral co-trimoxazole.…”