Efficacy of cotrimoxazole (Sulfamethoxazole-Trimethoprim) as a salvage therapy for the treatment of bone and joint infections (BJIs)

• Published in: PloS one 2019-10, Vol.14 (10), p.e0224106
• Main Authors: Deconinck, Laurene, Dinh, Aurélien, Nich, Christophe, Tritz, Thomas, Matt, Morgan, Senard, Olivia, Bessis, Simon, Bauer, Thomas, Rottman, Martin, Salomon, Jérome, Bouchand, Frédérique, Davido, Benjamin
• Format: Article
• Language: English
• Subjects: Adult; Aged; Anti-Bacterial Agents - therapeutic use; Antibiotics; Antimicrobial agents; Bacilli; Biology and life sciences; Bone Diseases, Infectious - drug therapy; Bone Diseases, Infectious - microbiology; Cotrimoxazole; Effectiveness; Female; Fluoroquinolones; Gram-negative bacilli; Gram-Negative Bacteria - isolation & purification; Gram-Negative Bacterial Infections - drug therapy; Gram-Negative Bacterial Infections - microbiology; Humans; Infections; Intravenous administration; Joint diseases; Joints (anatomy); Male; Medicine and Health Sciences; Middle Aged; Orthopedics; Patients; Prostheses; Prosthesis-Related Infections - drug therapy; Prosthesis-Related Infections - microbiology; Research and Analysis Methods; Retrospective Studies; Rifampin; Salvage Therapy; Staphylococcus infections; Sulfamethoxazole; Therapy; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination - therapeutic use
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0224106

Cotrimoxazole (Sulfamethoxazole-Trimethoprim, SXT) has interesting characteristics for the treatment of bone and joint infection (BJI): a broad spectrum of activity with adequate bone diffusion and oral and intravenous formulations. However, its efficacy and safety in BJIs are poorly documented and its use remains limited. We conducted a retrospective study in 2 reference centers for BJIs from 2013 to 2018 among patients treated with SXT for a BJI. Data were collected from patient's medical charts. Outcomes and adverse events were evaluated at day (D)7, D45 and D90. We analyzed 51 patients with a mean age of 60 ± 20 (SD) years of which 76% presented with an orthopedic device infection (ODI). Gram-negative bacilli (GNB) were involved in 47% of BJIs (n = 24). Moreover, they were often polymicrobial infections (41%). Doses of SXT ranged from 800/160mg bid (61%; n = 31) to 800/160mg tid (39%; n = 20). Median SXT treatment duration was 45 days (IQR 40-45). SXT was part of a dual therapy in 84% of patients (n = 43), associated mainly with fluoroquinolones (n = 17) or rifampicin (n = 14). Outcome was favorable at D7 in 98% (n = 50), at D45 in 88.2% (n = 45) and at D90 in 78.4% (n = 40). The second agent combined with SXT was not an independent factor of favorable outcome (p = 0.97). Adverse events were reported in 8% (n = 4) of patients, with a median of 21 days (IQR 20-30) from SXT initiation and led to discontinuation (n = 3). SXT appears to be effective for treatment of BJIs as a salvage therapy, even in GNB or polymicrobial infection, including ODI. Further data are needed to confirm SXT efficacy as an alternative oral regimen in BJIs.