Azithromycin in combination with riboflavin decreases the severity of Staphylococcus aureus infection induced septic arthritis by modulating the production of free radicals and endogenous cytokines.

OBJECTIVE AND DESIGN: To determine alternate therapeutic measures to combat Staphylococcus aureus induced arthritis. Thus, azithromycin was combined with riboflavin, which may combat the ROS production and inflammation. METHODS: An in vivo model of S. aureus infection-induced arthritis was set up by infecting mice with 5 × 106 bacterial cell/mouse. S. aureus was administered intravenously. Azithromycin and riboflavin was injected intraperitoneally at a single dose of 100 and 20 mg/kg body, respectively. The mice were sacrificed at 3, 9, 15 days post infection (dpi). TNF-α, IFN-γ, IL-6 and IL-10 from serum and SOD, catalase and reduced glutathione concentration were observed in hepatic, cardiac, renal and splenic tissue. RESULTS: CFU was found very prominent in spleen and joints and reduced in blood at 3 and 9 dpi. However, treatment with azithromycin and riboflavin completely eradicated the bacteria from blood and spleen. TNF-α, IFN-γ, IL-6, and MCP-1 were induced due to infection which were downregulated by treatment with azithromycin and riboflavin. Infected mice were also found to have altered antioxidant status, measured in terms of reduced glutathione and anti-oxidant enzymes such as SOD and catalase. CONCLUSION: These changes were found to be ameliorated when the animals were co-treated with azithromycin and riboflavin.

Ampicillin alone and in combination with riboflavin modulates Staphylococcus aureus infection induced septic arthritis in mice.

Effects of ampicillin (Amp) in combination with riboflavin on septic arthritis in mice infected with Staphylococcus aureus have been reported. Ampicillin was given at 100 mg/kg after 24 h of infection, followed by riboflavin (Ribo) at 20 mg/kg body wt, after 2 h of Amp treatment. Mice were sacrificed at 3, 9, 15 days post infection (dpi). Combined treatment of infected mice with ampicillin and riboflavin eradicated the bacteria from blood, spleen and synovial tissue and showed a significant gross reduction in arthritis, reduced serum levels of TNF-alpha and IFN-gamma. S. aureus infected mice exhibited higher synovial TNF-alpha and IL-6, which was also reduced by ampicillin and riboflavin treatment. S. aureus infected mice showed a disturbed antioxidant status measured in terms of cellular anti-oxidants like reduced glutathione and anti-oxidant enzymes such as superoxide dismutase and catalase and were ameliorated when the animals were co-treated with ampicillin along with riboflavin. Results of the study showed that combined treatment with anti-oxidant and antibiotic may protect from staphylococcal arthritis and may ameliorate oxidative stress caused by S. aureus infection.