INITIAL CHOICE OF ANTIBIOTIC FOR SEPTIC ARTHRITIS IN CHILDREN AFTER NEONATAL-PERIOD

Bacterial arthritis are serious infections involving the functionnal prognosis of the joint. Their evolution has been transformed by progresses in antibiotic and surgical treatment. Bacterial arthritis can be considered as joint abcess, so antibiotherapy is only a part of the treatment. Before starting antibiotherapy, efforts must be made to identify the pathogen. But unless direct examination of the joint fluid can provide orientation, Initial antibiotherapy is empirical, based on epidemiological considerations. Before the age of two years, Haemophilus influenzae and Staphylococcus aureus are prominent. After this age, staphylococcus is the most often pathogen with pneumococcus, Streptococcus pyogenes group A, meningococcus, and Haemophilus until 5 years of age. New antibiotic treatments have been recently studied for arthritis such as imipenem, cefotaxime + fosfomycin, ampicillin + sulbactam versus ceftriaxone. Without bacterial orientation in infants, initial treatment must be effective on betalactamase secreting H. influenzae and methicillin-resistant S. aureus. The association of a third generation cephalosporin (such as cefotaxime or ceftriaxone) with fosfomycin (100-200 mg/kg/d in 34 doses) is effective on these two pathogens and demonstrated an excellent diffusion in the infected site. As soon as the identification of the germ and its susceptibility to antibiotics can be obtained, the treatment should be adapted.