Definition
The term "septic arthritis" refers to a severe, acute or chronic inflammation of an infectious nature, triggered by bacteria (above all), viruses and mycetes; more precisely, to cause septic arthritis, pathogens must invade the synovial membrane, giving rise to an inflammatory process that is characterized by the formation of purulent exudate (filled with pus) within the joint space.
Causes
Bacteria are the etiopathological factors most responsible for septic arthritis, in particular Staphylococcus aureus (commensal bacterium normally found in the skin and in the nose) Streptococcus spp., Borrelia burgdorferi, Brucella burgdorferi and Neisseria gonorrhoeae . In addition to bacteria, mycetes (eg C. albicans) and some viruses (eg HBV, HIV 1, Parvovirus B19 ) can induce similar damage.
- Risk factors: AIDS, rheumatoid arthritis, arthrosis, catheterization, diabetes, haemophilia, bacterial endocarditis, implant of prosthesis, lupus, drug addiction
Symptoms
In the context of septic arthritis, pain in the affected joint, often sudden and acute, is an almost constant element; in addition to pain, which is accentuated with movement, the patient often complains of high fever, joint swelling, loss of appetite, irritability, acute synovitis, vasculitis, limited burning sensation, tachycardia (in the child).
- Complications: permanent functional impotence or inability to move the limb (25-50% of cases), death (5-10% of cases)
Information on Septic Arthritis - Drugs to Treat Septic Arthritis is not intended to replace the direct relationship between health professional and patient. Always consult your doctor and / or specialist before taking Septic Arthritis - Drugs to Treat Septic Arthritis.
drugs
To increase the chances of a good prognosis, and therefore of patient survival without complications, it is essential to start drug therapy for septic arthritis no later than 7 days after the onset of the very first symptoms: we remind you again that starting the therapy on a tight schedule minimizes the risk of suffering irreversible injuries.
After the diagnostic investigation and the assessment of the pathogen involved in septic arthritis, it is possible to proceed with the administration of antibiotic drugs. At first, if the diagnosis of septic arthritis had been ascertained but the pathogen is not yet isolated, it is possible to administer to the patient broad-spectrum antibiotics, therefore active against a rather wide range of pathogens: generally, antibiotics are used in grade to determine a good therapeutic action towards S. aureus and Streptococcus spp., since most septic arthritis depends on these pathogens.
However, after certain identification of the pathogen, it is advisable to modify the therapy, choosing a more specific drug. Antibiotic drugs are first administered intravenously (for three weeks); subsequently, the treatment can be converted into oral therapy (to be followed for another 2-4 weeks).
The most widely used antibiotic drugs in therapy are penicillins, gentamicin (possibly in combination with other antibiotics) and last-generation cephalosporins; not to forget, however, that bacteria can develop drug resistance, so therapy may be ineffective.
If the therapy just described was not sufficient to reverse the pathology, it is possible to drain the accumulated purulent material. In turn, drainage can be performed in two ways:
- Aspiration: first choice treatment, usable for all joints, except for hip and shoulder.
- Surgical drainage: in the case of septic arthritis, push at the level of the axial joints
- Benzilpenicillin (eg Benzil B, Penicillin G): especially indicated for the treatment of septic gonococcal arthritis. Start the therapy by taking the drug intravenously at a dose of 10 million units a day: proceed with this procedure for three weeks. After this period, it is possible to take the drug orally. Intra-articular administration of the drug did not lead to any advantage.
- Oxacillin (eg Penstapho): the drug (beta-lactamase-resistant semisynthetic penicillin) is prescribed for the treatment of gram positive septic arthritis; the dosage suggests to administer the drug at a dose of 2 grams, intravenously, every 4 hours. The duration of therapy should be determined by the doctor.
As an alternative to this drug, take clindamycin (eg Dalacin-T, Clindamycin BIN, Zindaclin, Dalacin-C), at a dose of 900 mg, ev, every 8 hours. In case of allergy to beta lactam antibiotic drugs, it is recommended to take vancomycin.
- Vancomycin (eg. Vancocin, Zengac, Maxivanil): glycopeptide antibiotic indicated for the treatment of meticillin-resistant staphylococcal arthritis (methicillin is another antibiotic); the chances of developing drug resistance increase in case of immunocompromise or drug addiction. The drug is generally taken at a dose of 30 mg / kg per day, intravenously, possibly fractionating the load in 4 doses or by continuous infusion.
- Ceftriaxone (eg Ceftriaxone, Pantoxon, Ragex, Deixim): third generation cephalosporin. It is recommended to take the drug at a dose of 1 gram intravenously, for 7-10 days. Indicated for the treatment of septic arthritis dependent on gram negative.
- Cefotaxima (eg Cefotaxima, Aximad, Lirgosin - third generation cephalosporin) or cefuroxine (eg Cefoprim, Tilexim, Zoref, Zinnat): these two drugs are two valid alternatives to cefatrixone. The dose for the treatment of gonococcal septic arthritis suggests taking 1 gram of active intravenously, three times a day, for only 2-3 days. After this time, it is recommended to take 400 mg of cefixime (eg Cefixoral, Suprax, Unixime: third generation cephalosporin), orally, twice a day or ciprofloxacin (eg Ciprofloxac, Samper, Ciproxin, Kinox) at a dose of 400-500 mg, 2 times a day, always by mouth.
In general, antibiotic therapy should be continued for two weeks in septic arthritis from streptococci, H. influenzae and gram-negative cocci (spherical pathogens); when staphylococci or Gram-nagative bacilli (cylindrical pathogens) are instead the main culprits of septic arthritis, therapy with antibiotic drugs must be continued for at least three weeks.
