Chemotherapy of acute bone and joint infections.

A series of 72 cases of acute osteomyelitis and acute septic arthritis has been presented. Operative intervention was necessary in 71% of our cases. All patients were treated with antibiotics. The initial antibiotic treatment in 39% of the cases was a combination of trimethoprim and sulfamethoxazole (TMP/SMX). This combination gave the lowest average time for subsidence of general symptoms and local signs. Staphylococcus aureus was the causative organism in 87% of our cases. Streptococcus pyogenes and Pneumococcus were the other causative organisms. Over half of the S. aureus infections were resistant to penicillin but none were resistant to TMP/SMX. Considering the low toxicity, good clinical response, lack of bacterial resistance, presence of synergy and broad antibacterial spectrum, the use of TMP/SMX is recommended in acute pyogenic bone and joint infections.