Difficulté de prise en charge des infections ostéo-articulaires à Madagascar / Treatment's problem of osteoarticular infections in Madagascar

The septic arthritis and osteitis treatment is based on germ(s) identification, which is not always obvious if we do not have at our disposal some proper technical platforms. Moreover, the population's low purchasing power compels us to prescribe the most affordable antibiotic. Regarding this context, this article is aimed at modelling a treatment strategy of osteoarticular infections for adult in developing countries, with international recommendations as our basis. It is a retrospective study which concerned inpatients admitted in the rheumatology-dermatology department of the Antananarivo University Hospital for septic arthritis and osteitis over all clinical patterns. We considered 9 cases including 7 septic arthritis and 2 osteitis. Staphylococcus aureus was found in two patients who had an osteitis, no germ was isolated for the patients with septic arthritis. Ceftriaxone 2 g per day combined with ciprofloxacine 1g per day by IV route, shifted by oxacilline 3 g per day and by ciprofloxacine 1g per day peroral proved to be effective for all patients. The international epidemiological data and the medicines cost were used as reference for the choice of antibiotics treatment. Our approach is worth being taken into consideration as an adaptation of the European recommendations to the realities of developing countries. In absence of any particular risk factor for any specific infection, the combination of ceftriaxone /ciprofloxacine IV route, shifted by oxacilline/ ciprofloxacine peroral is recommended.