Initial Therapy for Osteomyelitis and Septic Arthritis With Cefoxitin

Abstract

H. influenzae b developed m e n i n g i t i s a f t e r 3 days. T h e s e 3 , and -6 p a t i e n t s with negative c u l t u r e s , were dropped from the study.All o t h e r p a t i e n t s did well and received X 15.7 days I V c e f o x i t i n before switching t o o r a l a n t i m i c r o b i a l s . Adverse r e a c t i o n s included a l l e r g i c rash ( I ) , m i l d e o s i n o p h i l i a ( 2 ) a n d m i l d e l e v a t i o n of SGOT ( 1 ) . C e f o x i t i n was discontinued f o r reason of t h e r a s h ; a l l o t h e r r e a c t i o n s resolved when t h e drug was d i s c o n t i n u e d a t t h e completion of therapy.Neutropenia (PMN <1000/mm3) was seen in 2 p a t i e n t s but resolved spontaneously. Urinary reducing substances were d e t e c t e d in 5 c a s e s (22%). Cefoxit in a m e a r s t o be s a t i s f a ct o r y i n i t i a l therapy f o r osteomyel i t i s and k i p t i c a r t h r i t i s in p e d i a t r i c p a t i e n t s ; i t should not be used f o r i n f a n t s <2 y e a r s of age where 5 influenzae b i s suspected, due t o t h e p o s s i b l e development of meningitis.ORAL RIFAMPIN/TOPICAL BACITRACIN THERAPY ASANADJUNC-Keenan, G . Randall Andrew~. Dagmar A. Schnader, Robert E. Fleming and Cindy A. S l a t e n , S t . L o u i s U n i v e r s i t y , S t . L o u i s U n i v e r s i t y School of Medicine, Cardinal Glennon Memorial Hospital f o r Children. Department of ~e d i a t r i c s /~d o l e s c e n t Medicine, S t . Louis, MO. Several months a f t e r i n s t i t u t i o n of i n t e n s i v e i n f e c t i o n c o n t r o l measures in a neonatal i n t e n s i v e c a r e u n i t with a high i n f e c t i o n r a t e due t o m e t h i c i l l i n -r e s i s t a n t S. aureus (MRS), p a t i e n t s and personnel colonized with t h e~r~a n i s m~e t a t e d with rifampin ( R ) , b a c i t r a c i n (6) and hexachloraphene (H) in an attempt t o reduce t h e r e s e r v o i r of MRS. I n f e c t i o n r a t e s in t h e 6 months p r i o r t o t h e treatment (Rx) period were 11-22% and c o l o n i z a t i o n r a t e s ranged from 26-49%. 1 6 p a t i e n t s colonized with MRS i n n o s e , cord o r t r a c h e a and 5 personnel colonized i n t r a n a s a l l y w e r e included in t h e study. P a t i e n t s i t e s of MRS c o l o n i z a t i o n s includednose-4, cord-2, nose and cord-6, nose and trachea-4. Rx regimen included RZOmg/kg/day x5 days, B ointment t o nose, c o r d , tracheostomy s i t e x 6 d a i l y and H bath with r i n s e d a i l y x 2 days. Personnel received R 600 mg/day x5 days and B ointment i n t r a n a s a l l y 6x d a i l y . Repeat c u l t u r e s showed no MRS c o l o n i z a t i o n in 9/16 (56%) p a t i e n t s and 5/5 personnel 2-8 weeks a f t e r Rx. F a i l u r e o f Rx was not s t a t i s t i c a l l y a s s o c i a t e d with any p a r t i c u l a r s i t e ( s ) of c o l o n i z a t i o n . Adverse r e a c t i o n s t o Rx included vomiting (3/16) and t r a n s i e n t hypertransaminasemia (2/16). Previous studies of influenza A inf...