Septic arthritis: add-on corticosteroid to antibiotic is beneficial in children

Takeaway

• Add-on corticosteroids to antibiotic treatment in children with septic arthritis can reduce the number of days of hospi­talisation, duration of intravenous and oral antibiotics treatment and the number of days to normalisation of C-reactive protein.

Why this matters

• First meta-analysis to assess the beneficial effects of adjunct corticosteroids to antibiotic in patients with septic arthritis.
• Larger long-term studies are needed to evaluate relapse and adverse events associated with corticosteroids.

Study design

• Meta-analysis of 4 eligible studies, evaluating the adjunctive dexamethasone to antibiotic therapy in children with septic arthritis, identified after a search on Cochrane Library, Medline, PubMed, Embase, and ScienceDirect until January 2018.
• 348 children were included in the analysis (141 received dexamethasone and 207 received placebo).
• Outcomes: days of hospitalisation, days of intravenous antibiotic treatment, days of oral antibiotic treatment and days to normalisation of C-reactive protein.
• Funding: National Natural Science Foundation of China.

Key results

• Dexamethasone as add-on therapy with antibiotics significantly reduced:
  • number of hospitalisation days (2 studies; n=176; mean difference [MD], −4.226; P=.001),
  • number of days to normalisation of C-reactive protein (3 studies; n=288; MD, −3.075; P=.001),
  • number of days of intravenous antibiotic treatment (3 studies; n=288; MD, −3.593; P=.001) and
  • number of days of oral antibiotic treatment (2 studies; n=172; MD, −1.658; P=.001).

Limitations

• Small studies included.
• Short follow-up.