Long-Term Antibiotic Therapy for Bone and Joint Infections

Two oral combination regimens — rifampicin/linezolid and rifampicin/trimethoprim sulfamethoxazole — performed equally well.


Bone and joint infections are difficult to eradicate, especially in the presence of a prosthetic device, and require prolonged antibiotic therapy. Critical issues in the treatment of such infections are adequate tissue penetration of the antibiotic agent — or agents — chosen, development of resistance, and toxicity. Rifampicin has excellent activity against staphylococci (the pathogens most commonly responsible for bone and joint infections) and good tissue penetration. However, because resistance to this drug develops rapidly during monotherapy, rifampicin should be used only together with other antibiotics.

To find out which rifampicin combinations are efficacious and well tolerated during prolonged therapy, researchers in France conducted a retrospective study involving 56 patients who had been treated for chronic (>30 days duration) bone and joint infections at their institutions between February 2002 and December 2006. Twenty suffered from osteomyelitis, and 36 had infected prosthetic joints. Methicillin-resistant Staphylococcus aureus and methicillin-resistant coagulase-negative staphylococci were the pathogens isolated most frequently. The patients received rifampicin (10 mg/kg twice daily) plus either linezolid (600 mg twice daily) or trimethoprim and sulfamethoxazole (TMP-SMX; 8 and 40 mg/kg/day, respectively).

Cure rates 12 months after the end of treatment were similar between the linezolid/rifampicin and TMP-SMX/rifampicin groups (89.3% and 78.6%, respectively; P=0.47), as was the occurrence of adverse events (42.9% and 46.4%; P=1.00). Outcomes did not differ according to the underlying pathogen, the type of surgical management, or the presence of infected prosthetic material.


Citation(s):

Nguyen S et al. Efficacy and tolerance of rifampicin–linezolid compared with rifampicin–cotrimoxazole combinations in prolonged oral therapy for bone and joint infections. Clin Microbiol Infect 2009 Dec; 15:1163.