Efficacy of a combined oral clindamycin–rifampicin regimen for therapy of staphylococcal osteoarticular infections

Abstract

A majority of osteoarticular and implant-related infections are due to staphylococci and biofilm formation. Combined therapy including rifampicin is frequently recommended. Indeed, rifampicin penetrates biofilms and kills adherent staphylococci, but cannot be administered as monotherapy because of the rapid emergence of resistant mutants. While several antibiotic combinations including rifampicin have been implemented, evaluation of the clindamycin–rifampicin combination has been neglected, presumably because of the emergence of alternative combinations, such as quinolone–rifampicin, and the fear of potential antagonistic interactions. We report a limited series of 20 patients (3 immune-suppressed) with 6 arthroplasty infections, 4 other implant infections, 7 native arthritis, and 3 osteomyelitis, who were all successfully treated with this oral combination for >75% of the antibiotic course (median duration 45 days). The excellent outcomes obtained with this antimicrobial combination after a mean follow-up of 2.6 y (range 1.0–6.1 y) warrant further clinical and microbiological studies for implementing this regimen in routine practice.

Key words::

• Clindamycin
• infection
• rifampicin
• combination therapy
• osteoarticular infection

Acknowledgements

We are indebted to the following colleagues for data retrieval and help: Christophe Barea, Orthopaedic Surgery, Geneva University Hospitals; Jérôme Druon, Orthopaedic Surgery, Bretonneau Hospital, Tours; Dr Antoine Mouton, Professor Thierry Judet, and Professor Philippe Piriou, Orthopaedic Surgery, Raymond Poincaré Hospital, Paris Hospitals, Garches.

Declaration of interest: No financial support, grants, financial interests, or consultancy were received that could have led to a conflict of interest.