To the Editor.—
We refer to the article by Drs Tindall and Regan-Smith1 on gonococcal osteomyelitis. We have recently reported an additional case2 and reviewed three other cases not described in their article. Although gonococci that produce disseminated infections are usually exquisitely sensitive to penicillin, two of these additional cases of gonococcal osteomyelitis were caused by β-lactamase-producing strains.3,4 This observation calls attention to two points: (1) The setting of acute, asymmetric pauciarticular arthritis in a sexually active patient is complex. While the response of patients with gonococcal arthritis to penicillin is usually dramatic, failure to respond may not absolutely exclude the diagnosis. (2) Empiric therapy with cefoxitin or cefotaxime5 may be indicated for patients with presumed gonococcal arthritis or osteomyelitis who do not respond rapidly to penicillin and who may have had sexual exposure in areas where β-lactamase-producing gonococci have been isolated.
Black JR, Cohen MS. Treatment of Gonococcal Osteomyelitis. JAMA. 1984;252(11):1411. doi:10.1001/jama.1984.03350110017019
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