This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrowReprints and Permissions
Right arrow Copyright Information
Right arrow Books from ASM Press
Right arrow MicrobeWorld
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Stein, A.
Right arrow Articles by Raoult, D.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Stein, A.
Right arrow Articles by Raoult, D.

 Previous Article  |  Next Article 

Antimicrobial Agents and Chemotherapy, December 1998, p. 3086-3091, Vol. 42, No. 12
0066-4804/98/$04.00+0
Copyright © 1998, American Society for Microbiology. All rights reserved.

Ambulatory Treatment of Multidrug-Resistant Staphylococcus-Infected Orthopedic Implants with High-Dose Oral Co-trimoxazole (Trimethoprim-Sulfamethoxazole)

Andreas Stein,1 Jean Francois Bataille,2 Michel Drancourt,3 Georges Curvale,2 Jean Noel Argenson,4 Pierre Groulier,2 and Didier Raoult1,*

Microbiologie Clinique, Hôpital La Conception,1 and Chirurgie Orthopédique, Hôpital La Conception,2 13006 Marseille, and Microbiologie Clinique, Hôpital Salvator,3 Chirurgie Orthopédique, Hôpital Sainte Marguerite,4 13008 Marseille, France

Received 29 January 1998/Returned for modification 13 April 1998/Accepted 22 September 1998

We examined the effectiveness and safety of high-dose oral co-trimoxazole (trimethoprim-sulfamethoxazole) for the treatment of orthopedic implants infected with multidrug-resistant Staphylococcus species. The prospective study was conducted between 1989 and 1997 in a university medical center with ambulatory-care services. Patients eligible for the study consisted of those from whom multidrug-resistant Staphylococcus spp. organisms susceptible only to glycopeptides and co-trimoxazole were isolated from their orthopedic implants and for whom there was no contraindication to the treatment. All patients were treated orally with high-dose co-trimoxazole (trimethoprim, 20 mg/kg of body weight/day; sulfamethoxazole, 100 mg/kg/day). Patients with prosthetic hip infections were treated for 6 months, with removal of any unstable prosthesis after 5 months of treatment; patients with prosthetic knee infections were treated for 9 months, with removal of any unstable prosthesis after 6 months of treatment; and patients with infected osteosynthetic devices were treated for 6 months, with removal of the device after 3 months of treatment, if necessary. Monthly clinical evaluations were conducted until the completion of the treatment, and follow-up examinations were conducted regularly for up to 6 years. The overall treatment success rate was 66.7% (26 of 39 patients), with success rates of 62.5% for patients with prosthetic knee infections, 50% for those with prosthetic hip infections, and 78.9% for those with other device infections. Seventeen of the 28 (60.7%) patients who did not have any orthopedic material removed were cured. Eight patients stopped the treatment because of side effects, and one patient was not compliant. In three patients treatment failed because of the appearance of a resistant bacterium. Long-term oral ambulatory treatment with co-trimoxazole appears to be an effective alternative to the conventional medicosurgical treatment of chronic multidrug-resistant Staphylococcus-infected orthopedic implants which includes long-term intravenous antibiotic therapy combined with surgical debridement and removal of foreign material or its subsequent one- or two-stage replacement.

* Corresponding author. Mailing address: Université de la Méditerranée, Faculté de Médecine, Unité des Rickettsies, CNRS UPRES-A 6020, 27, boulevard Jean Moulin, 13385 Marseille Cédex 5, France. Phone: (33) 491.38.55.17. Fax: (33) 491.32.03.90. E-mail: didier.raoult{at}medecine.univ-mrs.fr.

Antimicrobial Agents and Chemotherapy, December 1998, p. 3086-3091, Vol. 42, No. 12
0066-4804/98/$04.00+0
Copyright © 1998, American Society for Microbiology. All rights reserved.


This article has been cited by other articles:

  • Entenza, J. M., Haldimann, A., Giddey, M., Lociuro, S., Hawser, S., Moreillon, P. (2009). Efficacy of Iclaprim against Wild-Type and Thymidine Kinase-Deficient Methicillin-Resistant Staphylococcus aureus Isolates in an In Vitro Fibrin Clot Model. Antimicrob. Agents Chemother. 53: 3635-3641 [Abstract] [Full Text]  
  • Phillips, S., MacDougall, C., Holdford, D. A (2007). Analysis of Empiric Antimicrobial Strategies for Cellulitis in the Era of Methicillin-Resistant Staphylococcus aureus. The Annals of Pharmacotherapy 41: 13-20 [Abstract] [Full Text]  
  • Gemmell, C. G., Edwards, D. I., Fraise, A. P., Gould, F. K., Ridgway, G. L., Warren, R. E., on behalf of the Joint Working Party of the Britis, (2006). Guidelines for the prophylaxis and treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections in the UK. J Antimicrob Chemother 57: 589-608 [Abstract] [Full Text]  
  • Lazzarini, L., Mader, J. T., Calhoun, J. H. (2004). Osteomyelitis in Long Bones. JBJS 86: 2305-2318 [Abstract] [Full Text]  
  • Darley, E. S. R., MacGowan, A. P. (2004). Antibiotic treatment of Gram-positive bone and joint infections. J Antimicrob Chemother 53: 928-935 [Abstract] [Full Text]  
  • Roux, V., Drancourt, M., Stein, A., Riegel, P., Raoult, D., La Scola, B. (2004). Corynebacterium Species Isolated from Bone and Joint Infections Identified by 16S rRNA Gene Sequence Analysis. J. Clin. Microbiol. 42: 2231-2233 [Abstract] [Full Text]  
  • Bernard, L., Hoffmeyer, P., Assal, M., Vaudaux, P., Schrenzel, J., Lew, D. (2004). Reply. J Antimicrob Chemother 53: 887-887 [Full Text]  
  • Darouiche, R. O. (2004). Treatment of Infections Associated with Surgical Implants. NEJM 350: 1422-1429 [Full Text]  
  • Bernard, L., Hoffmeyer, P., Assal, M., Vaudaux, P., Schrenzel, J., Lew, D. (2004). Trends in the treatment of orthopaedic prosthetic infections. J Antimicrob Chemother 53: 127-129 [Abstract] [Full Text]  
  • Adra, M., Lawrence, K. R (2004). Trimethoprim/Sulfamethoxazole for Treatment of Severe Staphylococcus aureus Infections. The Annals of Pharmacotherapy 38: 338-341 [Abstract] [Full Text]  
  • Tsukayama, D. T., Goldberg, V. M., Kyle, R. (2003). Diagnosis and Management of Infection After Total Knee Arthroplasty. JBJS 85: S75-80 [Full Text]  


Copyright © 2009 by the American Society for Microbiology.   For an alternate route to Journals.ASM.org, visit: http://intl-journals.asm.org | More Info»