ab214017

Efficacy of empirically prescribed amoxicillin and amoxicillin + clavulanic acid in children's reactive arthritis: A randomised trial

D. Astrauskiene

Department of Rheumatology, Institute of Experimental and Clinical Medicine, Vilnius University, Vilnius, Lithuania

ABSTRACT
Objective
To evaluate the efficacy of early empiric prescription of amoxicillin and amoxicillin + clavulanic acid in children with reactive arthritis (ReA) when the arthritis-triggering microorganism is not identified.

Methods
138 children, ranging in age from 2 to 16 years, with ReA of up to 3 months duration were randomly assigned to 3 groups and either prescribed antibacterial treatment with amoxicillin or amoxicillin + clavulanic acid (amoxicillin-potassium clavulanate combination) or were not given antibiotics (control group). Patients in all 3 groups were prescribed the usual treatment with nonsteroidal antiinflammatory drugs. Both groups of patients under antibacterial treatment were randomised into 2 subgroups: patients given a 10- to 14-day or a 28-day-duration antibacterial course. The results of the study were evaluated after 1 and 3 months of observation by determining the percentage of patients that had no clinical or laboratory signs of disease activity.

Results
After 1 month of observation no signs of disease activity were found in 48.0% of patients who were prescribed amoxicillin, in 58.5% of patients treated with amoxicillin + clavulanic acid, and only in 13.0% of patients from the control group (p < 0.001 for either antibacterial treatment in comparison with the control group). After 3 months of observation no disease activity was found in 92.0% of patients who used amoxicillin, in 95.1% of those treated with amoxicillin + clavulanic acid, and in 58.7% of children from the control group (p < 0.001 for either antibacterial treatment in comparison with the control group). There was no significant difference in the efficacy of amoxicillin and amoxicillin + clavulanic acid. The duration of the antibacterial course showed no influence on the results of treatment.

Conclusion
Amoxicillin or amoxicillin + clavulanic acid in 10- to 14-day courses are advisable, in addition to the antirheumatic treatment, for children in the early stage of ReA when the arthritis-triggering micro-organism is not identified.

Key words
Reactive arthritis, drug therapy, antibiotics, amoxicillin, amoxicillin-potassium clavulanate combination.

Danute Astrauskiene, MD, PhD, Senior Scientific Researcher, Department of Rheumatology, Institute of Experimental and Clinical Medicine, Vilnius University, Zygimantu 9, LT-2600 Vilnius, Lithuania.
E-mail: astrauskd@mail.lt