Because of the lack of specific guidelines for the treatment of K. kingae infections, patients with invasive disease have been treated with a wide array of different antibiotics according to protocols developed for specific conditions such as septic arthritis, osteomyelitis, endocarditis or meningitis caused by more familiar pathogens.
Initial drug therapy for skeletal infections in children usually consists of intravenous administration of second or third-generation cephalosporins (Yagupsky, 2004). This therapy is frequently changed to penicillin, ampicillin, or cefuroxime once the culture results and antibiotic susceptibility of the isolate are known. Clinical improvement, decreasing erythrocyte sedimentation rate and C-reactive protein values, as well as serum bactericidal levels, are used to guide switching to an oral 6-lactam drug and determine duration of antibiotic therapy (Yagupsky, 2004). Treatment has varied from 17 days to 3 months for arthritis, from 3 weeks to 6 months for osteomyelitis, and from 3 to 12 weeks for spondylodiscitis. Surgical drainage of the affected joint is usually reserved for children with septic arthritis involving the hip or shoulder. In patients with osteomyelitis, abscess formation, persistent bacte-remia or development of a bone sequestrum are considered indications for surgery. In patients with spondylodiscitis, detection of a para-spinal abscess or signs of neurological deficit make surgical drainage and decompression mandatory (Garron et al., 2002).
Patients with occult bacteremia have been generally given intravenous P-lactam antibiotics followed by oral therapy once the clinical condition improved. Total duration of therapy ranged from 7 days to 2 weeks in most cases (Yagupsky, 2004).
Patients with K. kingae endocarditis were usually administered intravenous P-lactam antibiotics alone or in combination with an aminoglycoside for 4 to 7 weeks. Early surgical interventions have been necessary in individuals with life-threatening complications unresponsive to medical therapy (Yagupsky, 2004).
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