Br J Sports Med 42:969-973 doi:10.1136/bjsm.2008.050369
  • Original article

Antibiotic treatment in patients with low-back pain associated with Modic changes Type 1 (bone oedema): a pilot study

  1. H B Albert1,
  2. C Manniche1,
  3. J S Sorensen1,
  4. B W Deleuran2
  1. 1
    The Back Research Center, Funen, University of Southern Denmark, Denmark
  2. 2
    Department of Rheumatology, Aarhus University Hospital and The Institute of Medical Microbiology and Immunology, Aarhus University, Aarhus, Denmark
  1. Hanne Albert, The Back Research Center, Lindevej 5, 5750 Ringe, Denmark; haal{at}
  • Accepted 4 July 2008
  • Published Online First 21 August 2008


Objective: The aim of this study was to assess the clinical effect of antibiotic treatment in a cohort of patients with low-back pain (LBP) and Modic changes Type 1 (bone oedema) following a lumbar herniated disc.

Design: This was a prospective uncontrolled trial of 32 LBP patients who had Modic changes and were treated with Amoxicillin-clavulanate (500 mg/125 mg) 3 × day for 90 days. All patients had previously participated in a randomised controlled trial (RCT) that investigated active conservative treatment for a lumbar herniated disc (n = 166). All patients in that RCT who had Modic changes and LBP at 14 months follow-up (n = 37) were invited to participate in this subsequent antibiotic trial but five did not meet the inclusion criteria.

Results: 29 patients completed the treatment, as three patients dropped out due to severe diarrhoea. At the end of treatment and at long-term follow-up (mean 10.8 months) there was both clinically important and statistically significant (p⩽0.001) improvement in all outcome measures: LBP intensity, number of days with pain, disease-specific and patient-specific function, and global perceived effect.

Conclusions: In this uncontrolled trial, the clinical effect of antibiotic treatment was large in a group of patients with Modic changes suffering from persistent LBP following a disc herniation. These results provide tentative support for a hypothesis that bacterial infection may play a role in LBP with Modic changes and indicate the need for randomised controlled trials to test this hypothesis.


  • Competing interests: None.