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Should steroids be used in the treatment of septic arthritis?
  1. Marina Macchiaiolo1,
  2. Paola Sabrina Buonuomo1,
  3. Maurizio Mennini2,
  4. Alberto Villani3,
  5. Andrea Bartuli1
  1. 1Rare Disease Unit, Pediatrics Medicine Department, Bambino Gesù Childrens Hospital, Rome, Italy
  2. 2Pediatrics Department, Università “La Sapienza”, Rome, Italy
  3. 3Pediatric Medicine and Infectious Disease, Pediatrics Medicine Department, Bambino Gesù Children's Hospital, Roma, Italy
  1. Correspondence to Dr Marina Macchiaiolo, Rare Disease Unit, Bambino Gesù Childrens Hospital, Piazza Sant'Onofrio 4, Rome 00164, Italy; marina.macchiaiolo{at}opbg.net

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Scenario

You are the paediatric registrar on duty when a 12-year-old boy is admitted to your ward with a strong suspicion of septic arthritis of the left knee. He plays soccer at competitive level; the boy and his parents are concerned about the long-term consequences for his playing.

While you are waiting for the result of the white count of the synovial fluid to confirm the diagnosis and promptly start antibiotic therapy, you remember a recent discussion about the use of steroids in infectious disease, and so you decide to review the literature and analyse whether the use of steroids as an adjuvant therapy could improve the prognosis of your patient.

Structured clinical question

In children with septic arthritis (population) does steroid therapy in addition to antibiotic therapy (intervention) reduce the duration of symptoms and late sequelae (outcome) compared with the antibiotic treatment only (comparison)?

Search strategy

Medline through PubMed and The Cochrane library from start until November 2013 were searched.

Keywords used were septic arthritis and steroid, dexamethasone and glucocorticoid limited to humans.

Two double-blind randomised placebo-controlled studies were found and included in this analysis (see table 1). Through bibliography analysis, two additional studies based …

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