Antibiotic use in Reactive Arthritis

Arthritis that arises following an infection (several days to weeks), although the pathogens cannot be cultured from the affected joints

Common causative agents:

• Panel of experts determined a specific list of gastrointestinal and urogenital pathogens that could be considered causative. These included Chlamydia trachomatis, Yersinia, Salmonella, Shigella, and Campylobacter.
• Escherichia coli, Clostridium difficile, and Chlamydia pneumoniae have since been added to the list
• Reactive arthritis has also been reported in patients with human immunodeficiency virus (HIV) infection, in which it is generally thought to be related to other infections to which patients have been exposed, rather than to HIV itself

Antibiotic:

• Antibiotics are not used to treat the arthritis specifically
• may be indicated for treatment of the underlying infection if there is evidence of ongoing genitourinary infection or carriage of potentially pathogenic organisms
• studies showed no difference compared to placebo in terms of remission

Enteric infection:

• antibiotics are not indicated for uncomplicated enteric infections
• patients with active enteric infections may require treatment. For example, therapy may be indicated in patients with severe gastrointestinal disease, in older adults, or in immunocompromised hosts
• oral fluoroquinolone (ciprofloxacin 500 mg twice daily, norfloxacin 400 mg twice daily, or levofloxacin 500 mg once daily) for three to five days. Azithromycin (500 mg PO once daily for three days) or erythromycin (500 mg PO twice daily for five days) are alternative agents, particularly if fluoroquinolone resistance is suspected

Genitourinary tract infection:

• patients with acute Chlamydia trachomatis infection of the genitourinary tract and their sexual partners should receive a standard antimicrobial treatment
• might prevent relapses of arthritis in patients with recurrent genitourinary tract symptoms alone
• azithromycin (1 gram single-dose therapy) with observed therapy when possible. Doxycycline (100 mg twice daily) can also be used in the nonpregnant patient for seven days

References:

1. www.uptodate.com