amoxicillin-potassium-clavulanate-combination and Discitis

The incidence of discitis following discectomy is reported at between 0.75% and 3.0%. We believe this rate could be reduced if an antibiotic that penetrated the disc tissue with an appropriate spectrum were to be given prophylactically to cover surgery. A prospective study of 20 patients undergoing routine lumbar discectomy was performed. Ten patients received Augmentin 1.2 g and ten received cefuroxime 1.5 g pre-operatively. In eight patients sequestrated disc fragments were analysed, and the majority were found to have drug levels higher than in the attached disc material; the reasons for this are discussed. We conclude that Augmentin penetrates damaged disc material to a limited extent, but cefuroxime achieves levels effective against the most commonly implicated pathogens in discitis tissue and is a rational choice of antibiotic for prophylaxis during lumbar discectomy.

Topics: Adult; Aged; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Antibiotic Prophylaxis; Cefuroxime; Discitis; Diskectomy; Dose-Response Relationship, Drug; Female; Humans; Incidence; Infusions, Intravenous; Intervertebral Disc; Lumbar Vertebrae; Male; Middle Aged; Prospective Studies; Treatment Outcome

A case report.. To report an unusual case of spondylodiscitis with multiple level involvement.. Spondylodiscitis, an infection of the intervertebral disc space, vertebral bodies, or the paraspinal epidural space can be a serious disease because of diagnostic delay and inadequate treatment.. A previously healthy, 52-year-old man was presented to our outpatient clinic with a complaint of acute, atraumatic onset of severe back pain for more than 1 month. Initially, he was misdiagnosed at another clinic as myofascial pain and treated with nonsteroidal anti-inflammatories and physical therapy, which he did not benefit from. He never complained of fever; however, laboratory tests revealed raised erythrocyte sedimentation values, increased C-reactive protein values but normal leukocyte count. Thoracal and lumbal plain radiographs were nonspecific. Magnetic resonance imaging demonstrated increased signal intensity in vertebral bodies and intervertebral disc space through T12-L4 and in the paravertebral musculature at L2-L3 with contrast enhancement. Blood cultures and computed tomography-guided needle biopsy and cultures were negative.. The patient was treated with oral amoxicillin and clavulanate and responded very well clinically; however, imaging examinations were repeated up to 6 months because of multilevel involvement. Follow-up magnetic resonance imaging findings at 3 months and 6 months showed decreased signal intensity, and luckily, there was no evidence of vertebral destruction.. Diagnosis of spondylodiscitis could be challenging and commonly missed; however, it should always be included in the differential diagnoses of back pain in the middle aged and healthy population.

Topics: Administration, Oral; Amoxicillin-Potassium Clavulanate Combination; Back Pain; Biomarkers; Biopsy; Blood Sedimentation; C-Reactive Protein; Discitis; Humans; Leukocyte Count; Lumbar Vertebrae; Magnetic Resonance Imaging; Male; Middle Aged; Severity of Illness Index; Thoracic Vertebrae; Tomography, X-Ray Computed; Treatment Outcome

In the pediatric literature, only 1 case of cervical spondylodiscitis from an ingested foreign body is reported and this was caused by a blunt radiolucent foreign body. The authors now describe a unique case of a 13-year-old teenaged boy who presented with neck pain 6 days after accidental ingestion of a sewing pin. Uncomplicated removal of this pin was followed in 36 days by the development of cervical spondylodiscitis that failed conservative management and required surgical debridement and arthrodesis. Physicians should be aware of the possibility of this complication in any patient that presents with neck pain after foreign body ingestion.

Topics: Accidents; Adolescent; Amoxicillin-Potassium Clavulanate Combination; Antibiotic Prophylaxis; Bone Plates; Ceftriaxone; Cervical Vertebrae; Clindamycin; Combined Modality Therapy; Deglutition Disorders; Discitis; Diskectomy; Emergencies; Equipment Contamination; Follow-Up Studies; Foreign Bodies; Humans; Laryngoscopy; Larynx; Male; Neck Pain; Oxacillin; Paresthesia; Penicillanic Acid; Pharynx; Piperacillin; Piperacillin, Tazobactam Drug Combination; Radiography; Recurrence; Retropharyngeal Abscess; Spinal Fusion; Vancomycin; Wounds, Penetrating