Thank you for your comments, which give us the opportunity to elaborate on some aspects of our study.
You question the drug and the duration of the treatment. Three independent international experts in infectious diseases were presented with the bacterial culture results of Stirling’s study [1] and all three recommended Amoxicillin–clavulanate. Therefore, treatment consisted of either Amoxicillin–clavulanate (500 mg/125 mg) (Bioclavid®) single dose 1 tablet three times a day or Amoxicillin–clavulanate (1,000 mg/250 mg) (Bioclavid®) 2 tablets three times a day, at 8-h intervals, for 100 days. This long duration of antibiotic treatment is commonly prescribed for post-operative discitis; we followed the recommendations of leading experts within microbiology. It is true that the study by Uçkay et al. [2] treated discitis for a shorter duration, but we did not refer to them as a reference for treatment time but rather for developments relating to the MRI scans. Indeed, this would have been difficult as they published their study 1 year after our study had completed the last follow-up of the patient.
We agree that we should all worry about multiresistant bacteria. However, resistance occurs primarily with partial treatment in contagious diseases. This is the primary reason for our adoption of the traditional therapeutic period for disc infections.
It is true that Fayad did not find bacteria, but Stirling et al. [1], Corsia et al. [3], Agarwal et al. [4] and Fritzell et al. [5] did. One should be extremely cautious, when presenting so called “negative studies” particularly in this field, as they are likely a result of the difficulty in culturing low virulent anaerobic bacteria, which requires special techniques, skills and time. Few laboratories are adequately equipped for this work.
Conflict of interest
None.
References
- 1.Stirling A, Worthington T, Rafiq M, et al. Association between sciatica and Propionebacterium acnes. Lancet. 2001;357:2024–2025. doi: 10.1016/S0140-6736(00)05109-6. [DOI] [PubMed] [Google Scholar]
- 2.Uçkay I, Dinh A, Vauthey L, Asseray N, Passuti N, Rottman M, Biziragusenyuka J, Riché A, Rohner P, Wendling D, Mammou S, Stern R, Hoffmeyer P, Bernard L. Spondylodiscitis due to Propionibacterium acnes: report of twenty-nine cases and a review of the literature. Clin Microbiol Infect. 2010;16:353–358. doi: 10.1111/j.1469-0691.2009.02801.x. [DOI] [PubMed] [Google Scholar]
- 3.Corsia MF, Wack M, Denys G (2003) Low virulence bacterial infections of intervertebral discs and the resultant spinal disease processes. Abstract from Scoliosis Research Society (SRS) annual meeting
- 4.Agarwal VJ, Golish R, Kondrashov D, Alamin TF. Results of bacterial culture from surgically excised intervertebral disc in 52 patients undergoing primary lumbar microdiscectomy at a single level. Spine J. 2010;10(9):S45–S46. doi: 10.1016/j.spinee.2010.07.126. [DOI] [Google Scholar]
- 5.Fritzell P, Bergström T, Welinder-Olsson C. Detection of bacterial DNA in painful degenerated spinal discs in patients without signs of clinical infection. Eur Spine J. 2004;13:702–706. doi: 10.1007/s00586-004-0719-z. [DOI] [PMC free article] [PubMed] [Google Scholar]