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We read with great interest the contribution of Ducours et al1 to our article,2 which randomised adult patients with native joint septic arthritis to either 2 or 4 weeks of systemic targeted antibiotic therapy after surgical drainage.2 Ducours et al reveal a similar experience with a short duration of targeted systemic antibiotic therapy for adult native joint bacterial arthritis due to gonococci and meningococci.1 There are substantial differences between our both studies: (1) Our arthritis episodes (majority hand arthritis) included all pyogenic bacteria, but not gonococci. In contrast, the Ducours group reports only Neisseria spp. (2) We randomised 154 cases, whereas Ducours et al resumed only 10 patients with mostly knee infections, although with a high proportion (30%) of bacteraemia. (3) Our minimal antibiotic treatment duration was 14 days (median 2 days of intravenous administration) compared with 7–10 days in the Ducours study (7 days of parenteral therapy).2 (4) All our cases were surgically debrided, whereas most gonococcal cases were treated conservatively.
All these differences are explained by the nature of the pathogens: Neisseria gonorrhoeae or N. meningitidis. Neisseria spp classically require only a few days of targeted empirical therapy, when compared with other arthritis pathogens. This is a particularity of the pathogen, which is very (rapidly) susceptible to all appropriate antibiotic agents.3 Indeed, native joint septic arthritis is a very heterogeneous group of clinical entities4 with different epidemiological, microbiological and therapeutic aspects in humans.5 Already in 2005, clinicians recommended a maximum therapy duration of 1 week with targeted antibiotics for disseminated gonococcal infection, including for arthritis.6 The later US 2015 Sexually Transmitted Diseases guidelines reconfirmed this duration indicating the duration as ‘for 7 days’.7 Hence, the good results by Ducours et al are not surprising.
Nevertheless, although investigating the most easily treatable bacterial pathogen in septic arthritis,4 Ducours et al underline the possibility of a short antibiotic treatment for septic arthritis,5 even in bacteraemic cases.1 This is important, because long parenteral antibiotic therapies (eg, 4 weeks) are still being reported for neisserial infections.8 We therefore congratulate our colleagues for their study and encourage other researchers to perform prospective trials aiming at the optimisation of systemic antibiotic treatment for adult native joint septic arthritis.
Handling editor Josef S Smolen
Contributors IU helped in the study concept and writing. KV performed the writing and corrections. EG helped in writing.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting or dissemination plans of this research.
Patient consent for publication Not required.
Provenance and peer review Commissioned; internally peer reviewed.
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