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 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.