Dr. Herzenberg has suggested that a return to the operating room and a 4- to 6-week course of antibiotics intravenously would have prevented the recurrent infection in the boy reported in our article (Can J Surg 1999;42[2]:145–8). This boy was initially treated with an arthrotomy, and a window was made in the capsule of the hip. Only the subcutaneous tissues were closed, and a closed suction drainage tube was placed in the hip to drain recurrent collections. We generally judge the duration of intravenous antibiotic therapy on clinical grounds, and the patient’s clinical response. We do not favour the prolonged use of antibiotics intravenously for soft-tissue infections, such as joint arthritis, believing that sufficient oral doses in compliant patients are equally effective.
Almost immediately postoperatively, this boy was weight bearing. His fever resolved and his range of motion improved. In retrospect, in this particular patient, perhaps a longer course of intravenous therapy might have been helpful, but at the time he seemed to have responded well. Although septic arthritis in older children is substantially more complicated and treatment is more difficult than in younger children with a short course, it is uncertain whether a return to the operating room or a longer course of intravenous antibiotics would have made any difference in this boy’s outcome.