Response to: ‘Is it currently reasonable to offer short 14-day antibiotic therapies after a surgical synovectomy in native joint septic arthritis?’ by Coiffier et al

We read with great interest the (mostly justified) scientific remarks of our colleagues Coiffier et al 1 to our article,2 randomising to either 2 or 4 weeks of systemic targeted antibiotic therapy after surgical drainage of native joint bacterial arthritis in adults. This was a classical non-inferiority trial detecting a similar outcome, similar mechanical sequels and a similar proportion of antibiotic-related adverse events in the short-antibiotic treatment group when compared with the classical long antibiotic administration of 4 weeks.2 However, native joint septic arthritis is a very heterogeneous group of clinical entities with different epidemiological, microbiological and therapeutic aspects in humans. The spectrum varies between adult and paediatric patients, with and without concomitant adjacent osteomyelitis or immune suppression, pathogens ( Staphylococcus aureus, Pseudomonas aeruginosa , gonococci, viruses), anatomical localisations (extremities, hand, diabetic foot, spine, mandibular, shoulder, sacroiliac), settings (orthopaedic departments vs rheumatological services), origins (spontaneous, intravenous drug abuse, surgical site infections, post-traumatic, bites) and management (surgeons, rheumatologists, internists, emergency vs elective drainage).3 Of note, our trial accepted all surgically drained arthritis cases but was sufficiently powered for the overall population plus the subgroup of hand and wrist arthritis cases, which in turn were …