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Double blind, randomized, placebo-controlled study of dexamethasone therapy for hematogenous septic arthritis in children.

AbstractBACKGROUND:
Septic arthritis is associated with residual dysfunction in 10 to 25% of affected children. Concentrations of cytokines detected in synovial fluid of children with bacterial arthritis correlate with the severity of inflammation. Treatment with dexamethasone decreased cartilage degradation in experimental Haemophilus influenzae b and Staphylococcus aureus arthritis.
ENDPOINTS:
To decrease the number of patients with residual dysfunction of the affected joint at the end of therapy and at 6 and 12 months and to speed clinical recovery by the administration of dexamethasone.
METHODS:
In a double blind manner we randomly selected 123 children with suspected hematogenous bacterial arthritis to receive dexamethasone or saline for 4 days. Antibiotic therapy was tailored according to age and the recovered pathogen.
RESULTS:
Of the 123 children enrolled, 61 were assigned to the dexamethasone group and 62 to the placebo group. Only 50 and 50 patients in each group were evaluable. The 2 groups of patients were comparable with respect to age, sex, duration of symptoms, pathogen, affected joint and therapeutic and diagnostic procedures. Staphylococcus aureus accounted for 67% of the isolates, Haemophilus influenzae type b for 13% and Streptococcus pneumoniae for 9%. Dexamethasone therapy reduced residual dysfunction at the end of therapy, P = 0.000068; at 6 months, P = 0.00007; and at 12 months, P = 0.00053 of follow-up and shortened the duration of symptoms (P = 0.001) during the acute phase. The 26% incidence of residual dysfunction in the control patients was similar to the 25% found in other series.
CONCLUSIONS:
A short course of dexamethasone reduced residual joint dysfunction and shortened significantly the duration of symptoms in children with documented hematogenous septic arthritis. These results suggest that a 4-day course of low dose dexamethasone given early benefits children with hematogenous septic arthritis.
AuthorsCarla M Odio, Tobias Ramirez, Gloria Arias, Arturo Abdelnour, Isabel Hidalgo, Marco L Herrera, Willy Bolaños, Jorge Alpízar, Patricio Alvarez
JournalThe Pediatric infectious disease journal (Pediatr Infect Dis J) Vol. 22 Issue 10 Pg. 883-8 (Oct 2003) ISSN: 0891-3668 [Print] United States
PMID14551489 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Randomized Controlled Trial)
Chemical References
  • Anti-Bacterial Agents
  • Dexamethasone
Topics
  • Anti-Bacterial Agents
  • Arthritis, Infectious (drug therapy, microbiology, physiopathology)
  • Blood-Borne Pathogens
  • Chemotherapy, Adjuvant
  • Confidence Intervals
  • Costa Rica
  • Dexamethasone (administration & dosage)
  • Dose-Response Relationship, Drug
  • Double-Blind Method
  • Drug Administration Schedule
  • Drug Therapy, Combination (therapeutic use)
  • Female
  • Follow-Up Studies
  • Humans
  • Injections, Intravenous
  • Male
  • Pain Measurement
  • Probability
  • Range of Motion, Articular (physiology)
  • Recovery of Function
  • Reference Values
  • Risk Assessment
  • Severity of Illness Index
  • Treatment Outcome

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