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INITIAL THERAPY FOR OSTEOMYELITIS AND SEPTIC ARTHRITIS WITH CEFOXITIN

Single drug therapy with a broad spectrum antibiotic is a desirable option for patients with bone and joint infections of unknown etiology. We initiated treatment for 23 children, ages 6 months-15 years (mean 6.5 years) with cefoxitin. The infecting organisms proved to be S. aureus-10, Strep. pneumoniae-2, H. influenzae b-2, and S. epidermidis, B. melaninogenicus, Moraxella sp. and Ps. fluorescens-1 each. No agent was identified in 6 cases. Initial clinical response was good in 21 cases (91%). One primary resistant organism (Ps. fluorescens) and one cephalosporin-tolerant S. aureus failed to respond. A third child with infection due to H. influenzae b developed meningitis after 3 days. These 3, and 6 patients with negative cultures, were dropped from the study. All other patients did well and received [xmacr ] 15.7 days IV cefoxitin before switching to oral antimicrobials. Adverse reactions included allergic rash (1), mildeosinophilia (2) and mild elevation of SGOT (1). Cefoxitin was discontinued for reason of the rash; all other reactions resolved when the drug was discontinued at the completion of therapy. Neutropenia (PMN <1000/mm3) was seen in 2 patients but resolved spontaneously. Urinary reducing substances were detected in 5 cases (22%). Cefoxitin appears to be satisfactory initial therapy for osteomyelitis and septic arthritis in pediatric patients; it should not be used for infants <2 years of age where H. influenzae b is suspected, due to the possible development of meningitis.