Is antibiotic therapy used to treat discitis (inflammation of the intervertebral disc)?

From the Guidelines

Discitis should be treated with antibiotics, but only after a microbiologic diagnosis is confirmed, if possible, to ensure targeted therapy. The treatment approach typically involves a 6-week course of antimicrobial therapy, as recommended by the 2015 Infectious Diseases Society of America (IDSA) clinical practice guidelines for the diagnosis and treatment of native vertebral osteomyelitis in adults 1.

Key Considerations

• The diagnosis of discitis can often be delayed, and it is essential to establish a microbiologic diagnosis through image-guided or intraoperative aspiration or biopsy of a disc space or vertebral endplate sample submitted for microbiologic and pathologic examination 1.
• Empiric antimicrobial therapy should be withheld, when possible, until a microbiologic diagnosis is confirmed, except in septic patients or patients with neurologic compromise 1.
• Definitive therapy should be based on the results of culture and in vitro susceptibility testing, with the majority of patients being cured with a 6-week course of antimicrobial therapy 1.

Treatment Approach

• The choice of antibiotics should be guided by the results of culture and susceptibility testing, with common pathogens including Staphylococcus aureus 1.
• Pain management is also an essential aspect of treatment, and surgical intervention may be necessary for cases with neurological deficits, spinal instability, or abscess formation.
• Treatment success is monitored through clinical improvement, normalization of inflammatory markers (ESR, CRP), and follow-up imaging studies.

Important Notes

• Guidelines cannot always account for individual variation among patients, and adherence to these guidelines should be voluntary, with the ultimate determination regarding their application to be made by the physician in light of each patient’s individual circumstances 1.

From the Research

Treatment of Discitis

• Discitis is typically treated with antibiotics, but the specific approach can vary depending on the circumstances 2.
• Surgical debridement or source control is a crucial aspect of treatment and can provide diagnosis specimens to guide antibiotic treatment 2.
• When culture results are positive, antibiotic treatment should be based on the results of antibiotic susceptibilities 2.
• A combination of agents, such as a quinolone or clindamycin, with fusidic acid or rifampicin, is indicated for empirical therapy 2.
• Early intravenous to oral switch and a minimum of six weeks of antibiotic treatment is recommended 2.

Characteristics of Discitis

• The majority of cases of discitis are caused by Staphylococcus spp (40.3%) and involve the lumbosacral region (52.3%) 3.
• 27.8% of cases are associated with neurological compromise, 30.4% develop an abscess, 6.6% are associated with instability, and 54.7% undergo surgery 3.
• The abscesses mostly involve the lumbosacral region (60.4%) with paravertebral localization 3.

Complications of Discitis

• Spinal cord compression mainly occurs in the cervical region (55.9%), neurological deficit is observed in over half of cases (65%), and surgery is required in most of the cases (83.9%) 3.
• The majority of cases of instability involve the lumbosacral region (53.3%) and undergo surgery (87%) 3.
• The focus of infection is mostly lumbosacral (61%) and almost all cases (95%) are treated surgically 3.