ORAL TREATMENT OF STAPHYLOCOCCUS SPP INFECTED ORTHOPEDIC IMPLANTS WITH FUSIDIC ACID OR OFLOXACIN IN COMBINATION WITH RIFAMPICIN

Oral therapy of staphylococcal infection of orthopaedic implants with 900 mg/day rifampicin combined with either 1.5 g/day fusidic acid for 5 days followed by 1 g/day thereafter, or 600 mg/day ofloxacin was com pared. Patients with an infected hip were treated for 6 months, with r emoval of any unstable prosthesis after 5 months' treatment and those with an infected knee prosthesis were treated for 9 months, with remov al of the prosthesis after 6 months of treatment. Patients with infect ions of other type of bone implants were treated for 6 months with rem oval of the implant after 3 months of treatment, if necessary. Cure wa s defined as the absence of clinical, microbiological and radiological evidence of infection 12 months after completion of treatment. The tr eatment of 46 of the 52 included in the study was evaluated for safety and that of 42 was assessed for efficacy. Overall treatment was succe ssful for 11 (55%) of 20 patients treated with rifampicin and fusidic acid group and for 11 (50%) of the 22 treated with rifampicin and oflo xacin. Treatment failed in four cases in each treatment group because of persistent infection. One patient given rifampicin and fusidic acid and three patients given rifampicin and ofloxacin failed treatment be cause of relapse. Superinfection led to failure in the remainder and w as due to staphylococci in all but one case in which Acinetobacter cal coaceticus var. anitratus was isolated. There were no side effects rel ated to study treatment. Oral treatment with rifampicin combined with fusidic acid may be a suitable alternative to the combination of rifam picin and ofloxacin for treating implant infections due to Staphylococ cus spp. either when the patient is intolerant to quinolones or when t he infecting organism is resistant to these drugs.