Efficacy of a combined oral clindamycin?rifampicin regimen for therapy of staphylococcal osteoarticular infections

Scand J Infect Dis. 2011 Dec;43(11-12):962-7. doi: 10.3109/00365548.2011.608082. Epub 2011 Sep 15.

Abstract

A majority of osteoarticular and implant-related infections are due to staphylococci and biofilm formation. Combined therapy including rifampicin is frequently recommended. Indeed, rifampicin penetrates biofilms and kills adherent staphylococci, but cannot be administered as monotherapy because of the rapid emergence of resistant mutants. While several antibiotic combinations including rifampicin have been implemented, evaluation of the clindamycin-rifampicin combination has been neglected, presumably because of the emergence of alternative combinations, such as quinolone-rifampicin, and the fear of potential antagonistic interactions. We report a limited series of 20 patients (3 immune-suppressed) with 6 arthroplasty infections, 4 other implant infections, 7 native arthritis, and 3 osteomyelitis, who were all successfully treated with this oral combination for >75% of the antibiotic course (median duration 45 days). The excellent outcomes obtained with this antimicrobial combination after a mean follow-up of 2.6 y (range 1.0-6.1 y) warrant further clinical and microbiological studies for implementing this regimen in routine practice.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents / administration & dosage*
  • Clindamycin / administration & dosage*
  • Drug Therapy, Combination / methods
  • Female
  • Humans
  • Male
  • Middle Aged
  • Osteoarthritis / drug therapy*
  • Osteoarthritis / microbiology*
  • Prosthesis-Related Infections / drug therapy
  • Prosthesis-Related Infections / microbiology
  • Rifampin / administration & dosage*
  • Staphylococcal Infections / drug therapy*
  • Staphylococcus / drug effects
  • Treatment Outcome
  • Young Adult

Substances

  • Anti-Bacterial Agents
  • Clindamycin
  • Rifampin