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Latest revision as of 00:08, 30 July 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Alejandro Lemor, M.D. [2]Venkata Sivakrishna Kumar Pulivarthi M.B.B.S [3]

Overview

Acute nongonococcal septic arthritis is a medical emergency which causes severe joint destruction and may increase both morbidity and mortality. So prompt diagnosis and treatment with antibiotic therapy and prompt drainage which reduces long-term complications. Vancomycin is recommended as either empirical therapy for patients with Gram-positive cocci on a synovial fluid Gram stain or as a component of regimen for those with a negative Gram stain if methicillin-resistant Staphylococcus aureus (MRSA) is prevalent. If Gram-negative bacilli are observed, an anti-pseudomonal Cephalosporin (e.g., Ceftazidime, Cefepime) should be administered. Carbapenems should be considered in conditions such as colonization or infection by extended-spectrum β-lactamase–producing pathogens. The optimal duration of therapy for septic arthritis remains uncertain. A minimum 3- to 4 week course is suggested for septic arthritis caused by S. aureus or Gram-negative bacteria. The use of Corticosteroids or intraarticular antibiotics is not advisable.^[1]^[2]

Medical Therapy

Empiric treatment should be commenced as soon as possible after culture samples have been obtained. The choice of empiric antibiotics should be determined on the basis of:^[3]^[4]^[5]

Gram stain results of synovial fluid analysis
Local prevalence of organisms and resistance patterns
Predisposing factors including intravenous drug use, hospitalization, or colonization of infectious pathogens, and risk for methicillin-resistant Staphylococcus aureus (MRSA)

If the patient fails to respond to initial treatment, consider:^[3]

Misidentification of causative pathogen
Infection with atypical pathogen
Concurrent osteomyelitis
Occult nidus of infection

Intra-articular antibiotics are not useful as it may increase infection rate and also causes chemical synovitis and cartilage toxicity.^[6]

Methicillin-resistant Staphylococcus aureus (MRSA)

Patient at high risk of methicillin-resistant Staphylococcus aureus (MRSA) include:^[7]^[2]

Known MRSA colonization or infection
Recent hospitalization
Nursing-home resident
Presence of leg ulcers
Indwelling catheters

Drainage or debridement of the joint space should always be performed in septic arthritis caused by MRSA. A 3 or 4 week course of therapy with Vancomycin (15–20 mg/kg/dose IV every 8–12 hours in adults or 15 mg/kg/dose IV every 6 hours in children), Daptomycin (6 mg/kg/day IV every 24 hours in adults or 6–10 mg/kg/dose IV every 24 hours in children), Linezolid (600 mg PO/IV twice daily in adults or 10 mg/kg/dose PO/IV every 8 hours in children), Clindamycin (600 mg PO/IV every 8 hours in adults or 10–13 mg/kg/dose PO/IV every 6–8 hours in children), and Trimethoprim-Sulfamethoxazole (3.5–4.0 mg/kg PO/IV every 8–12 hours in adults) have been used with success. A prolonged treatment of 4 to 6 weeks may be required if the condition is complicated by osteomyelitis.^[8]^[9]

Antimicrobial Regimen – Empiric Therapy

Newborn (< 1 week)	Newborn (1–4 weeks)	Infants (1–3 months)	Children (3 months–14 years)	Adults
High Risk for MRSA Preferred Regimen Vancomycin 18 mg/kg/day IV q12h AND Cefotaxime 50 mg/kg IV q12h Low Risk for MRSA Cefotaxime 50 mg/kg IV q12h AND Nafcillin 25 mg/kg IV q8h or Oxacillin 25 mg/kg IV q8h	High Risk for MRSA Preferred Regimen Vancomycin 22 mg/kg/day IV q12h AND Cefotaxime 50 mg/kg IV q8h Alternative Regimen Clindamycin 5 mg/kg IV q8h Low Risk for MRSA Preferred Regimen Cefotaxime 50 mg/kg IV q8h AND Nafcillin 37 mg/kg IV q6h OR Oxacillin 37 mg/kg IV q6h Alternative Regimen Clindamycin 5 mg/kg IV q6h	High Risk for MRSA Preferred Regimen Vancomycin 40 mg/kg/day IV q6–8h AND Cefotaxime 50 mg/kg IV q8h Low Risk for MRSA Preferred Regimen Cefotaxime 50 mg/kg IV q8h AND Nafcillin 37 mg/kg IV q6h OR Oxacillin 37 mg/kg IV q6h Alternative Regimen Clindamycin 7.5 mg/kg IV q6h	Preferred Regimen Vancomycin 40 mg/kg/day IV q6–8h AND Cefotaxime 50 mg/kg IV q8h	Monoarticular At risk for sexually-transmitted disease Preferred Regimen Ceftriaxone 1 g IV q24h OR Cefotaxime 1 g IV q8h OR Ceftizoxime 1 g IV q8h Alternative Regimen Vancomycin 1 g IV q12h Not at risk for sexually-transmitted disease Preferred Regimen Vancomycin 1 g IV q12h AND Ceftriaxone 1 g IV q24h OR Cefotaxime 1 g IV q8h OR Ceftizoxime 1 g IV q8h Alternative Regimen Vancomycin 1 g IV q12h AND Ciprofloxacin 400 mg IV q12h OR Levofloxacin 750 mg IV q 24 h Polyarticular Preferred Regimen Ceftriaxone 1 g IV q24h

Antimicrobial Regimen – Synovial Fluid Gram Stain-Based Therapy

Gram stain result	First choice antibiotic	Second choice antibiotic
Negative Gram stain	Vancomycin 15–20 mg/kg q8–12h and Ceftazidime 2 g IV q8h or Cefepime 2 g IV q8–12h	Daptomycin 6-8 mg/kg IV q24h or Linezolid 600 mg IV/PO q12h and Piperacillin-Tazobactam 4.5 g IV q6h or Aztreonam 2 g IV q8h or Imipenem 500 mg IV q6h or Meropenem 1 g IV q8h or Doripenem 500 mg IV q8h or Carbapenems
Gram-positive cocci	Vancomycin 15–20 mg/kg q8–12h	Daptomycin 6-8 mg/kg IV q24h or Linezolid 600 mg IV/PO q12h
Gram-negative cocci	Ceftriaxone 1 g IV q24h or Cefotaxime 1 g IV q8h
Gram-negative bacilli	Ceftazidime 2 g IV q8h or Cefepime 2 g IV q8–12h or Piperacillin-Tazobactam 4.5 g IV q6h	Aztreonam 2 g IV q8h or Imipenem 500 mg IV q6h or Meropenem 1 g IV q8h or Doripenem 500 mg IV q8h or

Antimicrobial Regimen – Pathogen Based Therapy

Microorgnaism		First choice antibiotic	Second choice antibiotic
Staphylococcus aureus	Methicillin-sensitive	Nafcillin 2 g IV QID or Clindamycin 900 mg IV TID	Cefazolin 0.25–1 g IV/IM q6–8h, Vancomycin 500 mg IV q6h or 1 g IV q12h
Staphylococcus aureus	Methicillin-resistant	Vancomycin 15–20 mg/kg IV q8–12h in adults or 15 mg/kg IV q6h in children or Linezolid 600 mg PO/IV q12h in adults or 10 mg/kg PO/IV q8h in children	Sulfamethoxazole-trimethoprim 3.5–4.0 mg/kg PO/IV q8–12h in adults or Minocycline ± rifampin
Coagulase-negative Staphylococcus spp	Methicillin-sensitive	Nafcillin 2 g IV QID or Clindamycin 900 mg IV/IM TID	Cefazolin 0.25–1 g IV/IM q6–8h vancomycin 500 mg IV q6h or 1 g IV BD
Coagulase-negative Staphylococcus spp	Methicillin-resistant	Vancomycin 1 g BD or Linezolid 600 mg BD	Sulfamethoxazole-trimethoprim or Minocycline ± rifampin or Clindamycin
Group A streptococcus, Strep. pyogenes		Penicillin G 2 million IV/IM every 4 h or Ampicillin 2 g IV QID	Clindamycin 600–1200 mg/day IV/IM q6–12h Cefazolin 0.25–1 g IV/IM q6–8h
Group B streptococcus, Strep. agalactiae		Penicillin G 2 million IV/IM every 4 h or Ampicillin 2 g IV every 6 h	Clindamycin 600–1200 mg/day IV/IM q6–12h Cefazolin 0.25–1 g IV/IM q6–8h
Enterococcus spp.		Ampicillin 2 g IV QID or Vancomycin 1 g IV BD	Ampicillin-sulbactam 3 g IV QID Linezolid 600 mg PO/IV BD
Escherichia coli		Ampicillin-sulbactam 3 g IV QID	Cefazolin 0.25–1 g IV/IM q6–8h, levofloxacin 500–750 mg IV/PO OD Gentamicin 3–5 mg/kg/day IV q6–8h Sulfamethoxazole-trimethoprim 8–10 mg/kg/day IV/PO q6–12h
Proteus mirabilis		Ampicillin 2 g IV QID or Levofloxacin 500 mg IV/PO OD	Cefazolin 0.25–1 g IV/IM q6–8h Sulfamethoxazole-trimethoprim 8–10 mg/kg/day IV/PO q6–12h Gentamicin 3–5 mg/kg/day IV q6–8h
Proteus vulgaris, Proteus rettgeri, Morganella morganii		Cefotaxime 2 g IV QID Imipenem 500 mg IV QID, or Levofloxacin 500 mg IV/PO OD	Gentamicin 3–5 mg/kg/day IV q6–8h, or Ticarcillin-clavulanate 3.1 g IV q4–6h
Serratia marcescens		Cefotaxime 2 g IV QID	Levofloxacin 500 mg IV/PO OD Gentamicin 3–5 mg/kg/day IV q6–8h Imipenem 500 mg IV QID
Pseudomonas aeruginosa		Cefepime 2 gm IV BD or Piperacillin 3 gm IV QID or Imipenem 500 IV QID	Ticarcillin-clavulanate 3.1 g IV q4–6h Tobramycin 3-5 mg/kg/day IV q6–8h Amikacin 15 mg/kg/day IV/IM q8–12h Ciprofloxacin 400 mg IV q8–12h
Neisseria gonorrhea		Ceftriaxone 2 g IV OD or Cefotaxime 1 g TID	Levofloxacin 500 mg IV/PO OD Ampicillin 2 g IV QID
Bacteroides fragilis group		Clindamycin 900 mg IV/IM TID or Metronidazole 500 mg TID	Ampicillin-sulbactam 3 g IV QID or Ticarcillin-clavulanic acid 3.1 g IV QID
Brucella melitensis		Doxycycline 100 mg PO BD and Streptomycin 15 mg/kg IM QID or Rifampin 600–900 mg QID	Doxycycline 100 mg PO BD and Gentamicin 5 mg/kg IV QID
Haemophilus influenzae		Amoxicillin-Clavulanate 875/125 mg PO BD or Cefprozil 500 mg PO BD or Cefuroxime 500 mg PO BD or Cefdinir 600 mg PO OD	Levofloxacin 750 mg IV/PO OD or Moxifloxacin 400 mg IV/PO OD or Clarithromycin 500 mg PO BD
Morganella morganii		Cefotaxime 2 g IV QID or Imipenem 500 mg IV QID or Levofloxacin 500 mg IV/PO OD	Gentamicin 3–5 mg/kg/day IV q6–8h or Ticarcillin-Clavulanate 3.1 g IV q4–6h
Tropheryma whipplei		Penicillin G 2 million units IV q4h for 2 weeks and Streptomycin 1 g IM/IV OD for 2 weeks, then TMP-SMX 160mg/800mg PO OD for 1 year	Ceftriaxone 2 g IV OD, then TMP-SMX 160mg/800mg PO OD for 1 year
Borrelia burgdorferi		Amoxicillin 500 mg TID for 28 days or Doxycycline 100 mg BD for 28 days or Cefuroxime 500 mg BD for 28 days	Azithromycin 500 mg PO OD for 7–10 days or Clarithromycin 500 mg PO BD for 14–21 days or Erythromycin 500 mg PO QID for 14–21 days

Duration of Antimicrobial Therapy

Clinical Setting	Duration
Staphylococcus aureus infection	3–4 weeks
Streptococcus groups A, B, C, G infection	3–4 weeks
Gram-negative bacilli infection	4 weeks
Brucella infection	6 weeks
Borrelia burgdorferi infection	30 days
Mycobacterium tuberculosis infection	9 months
Candida albicans infection	6 weeks
Prosthetic joint infection	6 weeks
Post-intraarticular injection or post-arthroscopy	14 days

Prosthetic joint infection

Management of prosthetic joint infection typically requires both surgical intervention and extended courses of antimicrobial therapy. Options of surgical approach include

Debridement with retention of prosthesis:
- Two-stage procedure (removal of prosthesis and cement with debridement of infected tissue and placement of a joint spacer, followed by prolonged antibiotics and replacement of prosthesis)
- One-stage procedure (removal of prosthesis, debridement, and replacement of prosthesis in a single procedure)
Permanent resection arthroplasty and amputation.

The surgical decision should be made by orthopedic surgeon with specialty consultation, such as infectious disease or plastic surgery as necessary.^[10]

Antibiotic selection and duration are determined according to the causative organisms and the surgical intervention performed. Antimicrobial agent should achieve adequate tissue concentrations and be effective against slow-growing organisms and biofilms in conformity with local antibiogram. Liaison with microbiology services is recommended. Empiric antibiotics may be required while culture results are pending and for the duration of treatment for culture-negative infection. MRSA coverage with glycopeptide (e.g., Vancomycin, Daptomycin) or Gram-negative coverage with Ceftriaxone should be considered when necessary. Empiric or pathogen-directed antibiotic therapy is generally instituted following the procedure.^[11]

The duration of antibiotic treatment varies depending on the surgical procedure undertaken. A six-week course of parenteral therapy is preferred if an infected prosthesis is retained, while two to four weeks of intravenous antibiotics may be sufficient if revision arthroplasty is performed. Oral antibiotics are commonly prescribed for three to six months in the setting of retained prosthesis compared with six weeks for revision arthroplasty.^[12]

References

↑ Mathews, Catherine J.; Weston, Vivienne C.; Jones, Adrian; Field, Max; Coakley, Gerald (2010-03-06). "Bacterial septic arthritis in adults". Lancet. 375 (9717): 846–855. doi:10.1016/S0140-6736(09)61595-6. ISSN 1474-547X. PMID 20206778.
↑ ^2.0 ^2.1 Sharff KA, Richards EP, Townes JM (2013) Clinical management of septic arthritis. Curr Rheumatol Rep 15 (6):332. DOI:10.1007/s11926-013-0332-4 PMID: 23591823
↑ ^3.0 ^3.1 Shirtliff ME, Mader JT (2002) Acute septic arthritis. Clin Microbiol Rev 15 (4):527-44. PMID: 12364368
↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
↑ Mathews, Catherine J.; Weston, Vivienne C.; Jones, Adrian; Field, Max; Coakley, Gerald (2010-03-06). "Bacterial septic arthritis in adults". Lancet. 375 (9717): 846–855. doi:10.1016/S0140-6736(09)61595-6. ISSN 1474-547X. PMID 20206778.
↑ Stutz G, Kuster MS, Kleinstück F, Gächter A (2000) Arthroscopic management of septic arthritis: stages of infection and results. Knee Surg Sports Traumatol Arthrosc 8 (5):270-4. DOI:10.1007/s001670000129 PMID: 11061294
↑ Liu, Catherine; Bayer, Arnold; Cosgrove, Sara E.; Daum, Robert S.; Fridkin, Scott K.; Gorwitz, Rachel J.; Kaplan, Sheldon L.; Karchmer, Adolf W.; Levine, Donald P.; Murray, Barbara E.; J Rybak, Michael; Talan, David A.; Chambers, Henry F.; Infectious Diseases Society of America (2011-02-01). "Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 52 (3): –18-55. doi:10.1093/cid/ciq146. ISSN 1537-6591. PMID 21208910.
↑ Liu, Catherine; Bayer, Arnold; Cosgrove, Sara E.; Daum, Robert S.; Fridkin, Scott K.; Gorwitz, Rachel J.; Kaplan, Sheldon L.; Karchmer, Adolf W.; Levine, Donald P.; Murray, Barbara E.; J Rybak, Michael; Talan, David A.; Chambers, Henry F.; Infectious Diseases Society of America (2011-02-01). "Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 52 (3): –18-55. doi:10.1093/cid/ciq146. ISSN 1537-6591. PMID 21208910.
↑ Mathews, Catherine J.; Weston, Vivienne C.; Jones, Adrian; Field, Max; Coakley, Gerald (2010-03-06). "Bacterial septic arthritis in adults". Lancet. 375 (9717): 846–855. doi:10.1016/S0140-6736(09)61595-6. ISSN 1474-547X. PMID 20206778.
↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
↑ Matthews, Philippa C.; Berendt, Anthony R.; McNally, Martin A.; Byren, Ivor (2009). "Diagnosis and management of prosthetic joint infection". BMJ (Clinical research ed.). 338: –1773. ISSN 1756-1833. PMID 19482869.
↑ Matthews, Philippa C.; Berendt, Anthony R.; McNally, Martin A.; Byren, Ivor (2009). "Diagnosis and management of prosthetic joint infection". BMJ (Clinical research ed.). 338: –1773. ISSN 1756-1833. PMID 19482869.

[1] Mathews, Catherine J.; Weston, Vivienne C.; Jones, Adrian; Field, Max; Coakley, Gerald (2010-03-06). "Bacterial septic arthritis in adults". Lancet. 375 (9717): 846–855. doi:10.1016/S0140-6736(09)61595-6. ISSN 1474-547X. PMID 20206778.

[pmid23591823-2] 2.0 ^2.1 Sharff KA, Richards EP, Townes JM (2013) Clinical management of septic arthritis. Curr Rheumatol Rep 15 (6):332. DOI:10.1007/s11926-013-0332-4 PMID: 23591823

[pmid12364368-3] 3.0 ^3.1 Shirtliff ME, Mader JT (2002) Acute septic arthritis. Clin Microbiol Rev 15 (4):527-44. PMID: 12364368

[4] Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.

[5] Mathews, Catherine J.; Weston, Vivienne C.; Jones, Adrian; Field, Max; Coakley, Gerald (2010-03-06). "Bacterial septic arthritis in adults". Lancet. 375 (9717): 846–855. doi:10.1016/S0140-6736(09)61595-6. ISSN 1474-547X. PMID 20206778.

[pmid11061294-6] Stutz G, Kuster MS, Kleinstück F, Gächter A (2000) Arthroscopic management of septic arthritis: stages of infection and results. Knee Surg Sports Traumatol Arthrosc 8 (5):270-4. DOI:10.1007/s001670000129 PMID: 11061294

[7] Liu, Catherine; Bayer, Arnold; Cosgrove, Sara E.; Daum, Robert S.; Fridkin, Scott K.; Gorwitz, Rachel J.; Kaplan, Sheldon L.; Karchmer, Adolf W.; Levine, Donald P.; Murray, Barbara E.; J Rybak, Michael; Talan, David A.; Chambers, Henry F.; Infectious Diseases Society of America (2011-02-01). "Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 52 (3): –18-55. doi:10.1093/cid/ciq146. ISSN 1537-6591. PMID 21208910.

[8] Liu, Catherine; Bayer, Arnold; Cosgrove, Sara E.; Daum, Robert S.; Fridkin, Scott K.; Gorwitz, Rachel J.; Kaplan, Sheldon L.; Karchmer, Adolf W.; Levine, Donald P.; Murray, Barbara E.; J Rybak, Michael; Talan, David A.; Chambers, Henry F.; Infectious Diseases Society of America (2011-02-01). "Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 52 (3): –18-55. doi:10.1093/cid/ciq146. ISSN 1537-6591. PMID 21208910.

[9] Mathews, Catherine J.; Weston, Vivienne C.; Jones, Adrian; Field, Max; Coakley, Gerald (2010-03-06). "Bacterial septic arthritis in adults". Lancet. 375 (9717): 846–855. doi:10.1016/S0140-6736(09)61595-6. ISSN 1474-547X. PMID 20206778.

[10] Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.

[11] Matthews, Philippa C.; Berendt, Anthony R.; McNally, Martin A.; Byren, Ivor (2009). "Diagnosis and management of prosthetic joint infection". BMJ (Clinical research ed.). 338: –1773. ISSN 1756-1833. PMID 19482869.

[12] Matthews, Philippa C.; Berendt, Anthony R.; McNally, Martin A.; Byren, Ivor (2009). "Diagnosis and management of prosthetic joint infection". BMJ (Clinical research ed.). 338: –1773. ISSN 1756-1833. PMID 19482869.

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@@ Line 1: / Line 1: @@
-__NOTOC____NOEDITSECTION__
+__NOTOC__
 {{Septic arthritis}}
-{{CMG}}; {{AE}} Jumana Nagarwala, M.D., ''Senior Staff Physician, Department of Emergency Medicine, Henry Ford Hospital''; {{CZ}}; {{AL}}
+{{CMG}}; {{AE}}{{AL}}{{VSKP}}
 ==Overview==
-Acute non-[[gonococcal]] septic arthritis is a medical emergency which requires prompt drainage followed by empiric antimicrobial therapy.  '''[[Vancomycin]]''' is recommended as either empirical therapy for patients with [[Gram-positive cocci]] on a [[synovial fluid]] [[Gram stain]] or as a component of regimen for those with a negative [[Gram stain]] if [[MRSA|methicillin-resistant ''Staphylococcus aureus'' (MRSA)]] is prevalent.  If [[Gram-negative bacilli]] are observed, an anti-[[pseudomonal]] [[Cephalosporin]] (e.g., '''[[Ceftazidime]]''', '''[[Cefepime]]''') should be administered.  '''[[Carbapenems]]''' should be considered in conditions such as colonization or infection by [[ESBL|extended-spectrum β-lactamase]]–producing pathogens.  The optimal duration of therapy for septic arthritis remains uncertain.  A minimum 3- to 4-week course is suggested for septic arthritis caused by ''[[S. aureus]]'' or [[Gram-negative bacteria]].  The use of [[Corticosteroids]] or intraarticular [[antibiotics]] is not advisable.<ref>{{Cite journal| doi = 10.1016/S0140-6736(09)61595-6| issn = 1474-547X| volume = 375| issue = 9717| pages = 846–855| last1 = Mathews| first1 = Catherine J.| last2 = Weston| first2 = Vivienne C.| last3 = Jones| first3 = Adrian| last4 = Field| first4 = Max| last5 = Coakley| first5 = Gerald| title = Bacterial septic arthritis in adults| journal = Lancet| date = 2010-03-06| pmid = 20206778}}</ref><ref>{{Cite journal| doi = 10.1007/s11926-013-0332-4| issn = 1534-6307| volume = 15| issue = 6| pages = 332| last1 = Sharff| first1 = Katie A.| last2 = Richards| first2 = Eric P.| last3 = Townes| first3 = John M.| title = Clinical management of septic arthritis| journal = Current Rheumatology Reports| date = 2013-06| pmid = 23591823}}</ref>
+Acute nongonococcal septic arthritis is a medical emergency which causes severe joint destruction and may increase both morbidity and mortality. So prompt diagnosis and treatment with antibiotic therapy and  prompt drainage which reduces long-term complications. '''[[Vancomycin]]''' is recommended as either empirical therapy for patients with [[Gram-positive cocci]] on a [[synovial fluid]] [[Gram stain]] or as a component of regimen for those with a negative [[Gram stain]] if [[MRSA|methicillin-resistant ''Staphylococcus aureus'' (MRSA)]] is prevalent.  If [[Gram-negative bacilli]] are observed, an anti-[[pseudomonal]] [[Cephalosporin]] (e.g., '''[[Ceftazidime]]''', '''[[Cefepime]]''') should be administered.  '''[[Carbapenems]]''' should be considered in conditions such as colonization or infection by [[ESBL|extended-spectrum β-lactamase]]–producing pathogens.  The optimal duration of therapy for septic arthritis remains uncertain.  A minimum 3- to 4 week course is suggested for septic arthritis caused by ''[[S. aureus]]'' or [[Gram-negative bacteria]].  The use of [[Corticosteroids]] or intraarticular [[antibiotics]] is not advisable.<ref>{{Cite journal| doi = 10.1016/S0140-6736(09)61595-6| issn = 1474-547X| volume = 375| issue = 9717| pages = 846–855| last1 = Mathews| first1 = Catherine J.| last2 = Weston| first2 = Vivienne C.| last3 = Jones| first3 = Adrian| last4 = Field| first4 = Max| last5 = Coakley| first5 = Gerald| title = Bacterial septic arthritis in adults| journal = Lancet| date = 2010-03-06| pmid = 20206778}}</ref><ref name="pmid23591823">Sharff KA, Richards EP, Townes JM (2013) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=23591823 Clinical management of septic arthritis.] ''Curr Rheumatol Rep'' 15 (6):332. [http://dx.doi.org/10.1007/s11926-013-0332-4 DOI:10.1007/s11926-013-0332-4] PMID: [https://pubmed.gov/23591823 23591823]</ref>
 ==Medical Therapy==
-Empiric treatment should be commenced as soon as possible after culture samples have been obtained.  The choice of empiric antibiotics should be determined on the basis of:<ref>{{Cite journal| issn = 0893-8512| volume = 15| issue = 4| pages = 527–544| last1 = Shirtliff| first1 = Mark E.| last2 = Mader| first2 = Jon T.| title = Acute septic arthritis| journal = Clinical Microbiology Reviews| date = 2002-10| pmid = 12364368| pmc = PMC126863}}</ref><ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref><ref>{{Cite journal| doi = 10.1016/S0140-6736(09)61595-6| issn = 1474-547X| volume = 375| issue = 9717| pages = 846–855| last1 = Mathews| first1 = Catherine J.| last2 = Weston| first2 = Vivienne C.| last3 = Jones| first3 = Adrian| last4 = Field| first4 = Max| last5 = Coakley| first5 = Gerald| title = Bacterial septic arthritis in adults| journal = Lancet| date = 2010-03-06| pmid = 20206778}}</ref>
+Empiric treatment should be commenced as soon as possible after culture samples have been obtained.  The choice of empiric antibiotics should be determined on the basis of:<ref name="pmid12364368">Shirtliff ME, Mader JT (2002) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12364368 Acute septic arthritis.] ''Clin Microbiol Rev'' 15 (4):527-44. PMID: [https://pubmed.gov/12364368 12364368]</ref><ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref><ref>{{Cite journal| doi = 10.1016/S0140-6736(09)61595-6| issn = 1474-547X| volume = 375| issue = 9717| pages = 846–855| last1 = Mathews| first1 = Catherine J.| last2 = Weston| first2 = Vivienne C.| last3 = Jones| first3 = Adrian| last4 = Field| first4 = Max| last5 = Coakley| first5 = Gerald| title = Bacterial septic arthritis in adults| journal = Lancet| date = 2010-03-06| pmid = 20206778}}</ref>
 * [[Gram stain]] results of [[synovial fluid]] analysis
 * Local prevalence of organisms and resistance patterns
 * Predisposing factors including intravenous drug use, hospitalization, or colonization of infectious pathogens, and risk for [[MRSA|methicillin-resistant ''Staphylococcus aureus'' (MRSA)]]
-If the patient fails to respond to initial treatment, consider:<ref>{{Cite journal| issn = 0893-8512| volume = 15| issue = 4| pages = 527–544| last1 = Shirtliff| first1 = Mark E.| last2 = Mader| first2 = Jon T.| title = Acute septic arthritis| journal = Clinical Microbiology Reviews| date = 2002-10| pmid = 12364368| pmc = PMC126863}}</ref>
+If the patient fails to respond to initial treatment, consider:<ref name="pmid12364368">Shirtliff ME, Mader JT (2002) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12364368 Acute septic arthritis.] ''Clin Microbiol Rev'' 15 (4):527-44. PMID: [https://pubmed.gov/12364368 12364368]</ref>
 * Misidentification of causative pathogen
 * Infection with atypical pathogen
 * Concurrent [[osteomyelitis]]
 * Occult nidus of infection
+Intra-articular antibiotics are not useful as it may increase infection rate and also causes [[Synovitis|chemical synovitis]] and [[Cartilage|cartilage toxicity]].<ref name="pmid11061294">Stutz G, Kuster MS, Kleinstück F, Gächter A (2000) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=11061294 Arthroscopic management of septic arthritis: stages of infection and results.] ''Knee Surg Sports Traumatol Arthrosc'' 8 (5):270-4. [http://dx.doi.org/10.1007/s001670000129 DOI:10.1007/s001670000129] PMID: [https://pubmed.gov/11061294 11061294]</ref>
-===Specific Considerations===
-=====Tailoring antibiotic coverage to clinical scenario=====
-* Neonate
-: ''[[Staphylococcus aureus]]''
-* Infant &lt; 2 years
-: [[Haemophilus influenzae]], ''[[Staphylococcus aureus]]''
-* Infant &gt; 2 years
-: ''[[Staphylococcus aureus]]''
-* Young adults (sexually active)
-: ''[[Neisseria gonorrhoeae]]''
-* Elderly adults
-: ''[[Staphylococcus aureus]]'', [[streptococci]], [[Gram-negative bacilli]]
-* Post-aspiration or injection
-: ''[[Staphylococcus aureus]]''
-* Trauma
-: [[Gram-negative bacilli]], [[anaerobes]], ''[[Staphylococcus aureus]]''
-* Prosthesis
-: ''[[Staphylococcus epidermidis]]'' (early infection)
-: [[Gram-positive cocci]], [[anaerobes]] (late infection)
-* Injecting drug use
-: Atypical [[gram-negative bacilli]] including [[Pseudomonas]]
-* Rheumatoid arthritis
-: ''[[Staphylococcus aureus]]''
-* Systemic lupus erythematosus
-: [[Salmonella]]
-* Sickle cell anemia
-: [[Salmonella]]
-* Hemophilia
-: ''[[Staphylococcus aureus]]'', [[streptococci]], [[Gram-negative bacilli]]
-* Immunosuppression
-: ''[[Staphylococcus aureus]]'', [[Mycobacterium]], [[fungi]]<ref>{{cite book | last = Firestein | first = Gary | title = Kelley's textbook of rheumatology | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2013 | isbn = 978-1437717389 }}</ref>
 =====Methicillin-resistant ''Staphylococcus aureus'' (MRSA)=====
-Risk factors for septic arthritis caused by methicillin-resistant Staphylococcus aureus (MRSA) include:<ref>{{Cite journal| doi = 10.1093/cid/ciq146| issn = 1537-6591| volume = 52| issue = 3| pages = –18-55| last1 = Liu| first1 = Catherine| last2 = Bayer| first2 = Arnold| last3 = Cosgrove| first3 = Sara E.| last4 = Daum| first4 = Robert S.| last5 = Fridkin| first5 = Scott K.| last6 = Gorwitz| first6 = Rachel J.| last7 = Kaplan| first7 = Sheldon L.| last8 = Karchmer| first8 = Adolf W.| last9 = Levine| first9 = Donald P.| last10 = Murray| first10 = Barbara E.| last11 = J Rybak| first11 = Michael| last12 = Talan| first12 = David A.| last13 = Chambers| first13 = Henry F.| last14 = Infectious Diseases Society of America| title = Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children| journal = Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America| date = 2011-02-01| pmid = 21208910}}</ref><ref>{{Cite journal| doi = 10.1007/s11926-013-0332-4| issn = 1534-6307| volume = 15| issue = 6| pages = 332| last1 = Sharff| first1 = Katie A.| last2 = Richards| first2 = Eric P.| last3 = Townes| first3 = John M.| title = Clinical management of septic arthritis| journal = Current Rheumatology Reports| date = 2013-06| pmid = 23591823}}</ref>
+Patient at high risk of [[Methicillin-resistant staphylococcus aureus|methicillin-resistant Staphylococcus aureus]] (MRSA) include:<ref>{{Cite journal| doi = 10.1093/cid/ciq146| issn = 1537-6591| volume = 52| issue = 3| pages = –18-55| last1 = Liu| first1 = Catherine| last2 = Bayer| first2 = Arnold| last3 = Cosgrove| first3 = Sara E.| last4 = Daum| first4 = Robert S.| last5 = Fridkin| first5 = Scott K.| last6 = Gorwitz| first6 = Rachel J.| last7 = Kaplan| first7 = Sheldon L.| last8 = Karchmer| first8 = Adolf W.| last9 = Levine| first9 = Donald P.| last10 = Murray| first10 = Barbara E.| last11 = J Rybak| first11 = Michael| last12 = Talan| first12 = David A.| last13 = Chambers| first13 = Henry F.| last14 = Infectious Diseases Society of America| title = Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children| journal = Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America| date = 2011-02-01| pmid = 21208910}}</ref><ref name="pmid23591823">Sharff KA, Richards EP, Townes JM (2013) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=23591823 Clinical management of septic arthritis.] ''Curr Rheumatol Rep'' 15 (6):332. [http://dx.doi.org/10.1007/s11926-013-0332-4 DOI:10.1007/s11926-013-0332-4] PMID: [https://pubmed.gov/23591823 23591823]</ref>
-* Known MRSA colonization or infection
+* Known [[Methicillin-resistant staphylococcus aureus|MRSA]] colonization or infection
 * Recent hospitalization
 * Nursing-home resident
 * Presence of leg ulcers
-* Indwelling catheters
+* Indwelling [[catheters]]
+Drainage or [[debridement]] of the joint space should always be performed in septic arthritis caused by [[MRSA]].  A 3 or 4 week course of therapy with '''[[Vancomycin]]''' (15–20 mg/kg/dose IV every 8–12 hours in adults or 15 mg/kg/dose IV every 6 hours in children), '''[[Daptomycin]]''' (6 mg/kg/day IV every 24 hours in adults or 6–10 mg/kg/dose IV every 24 hours in children), '''[[Linezolid]]''' (600 mg PO/IV twice daily in adults or 10 mg/kg/dose PO/IV every 8 hours in children), '''[[Clindamycin]]''' (600 mg PO/IV every 8 hours in adults or 10–13 mg/kg/dose PO/IV every 6–8 hours in children), and '''[[Trimethoprim-Sulfamethoxazole]]''' (3.5–4.0 mg/kg PO/IV every 8–12 hours in adults) have been used with success.  A prolonged treatment of 4 to 6 weeks may be required if the condition is complicated by [[osteomyelitis]].<ref>{{Cite journal| doi = 10.1093/cid/ciq146| issn = 1537-6591| volume = 52| issue = 3| pages = –18-55| last1 = Liu| first1 = Catherine| last2 = Bayer| first2 = Arnold| last3 = Cosgrove| first3 = Sara E.| last4 = Daum| first4 = Robert S.| last5 = Fridkin| first5 = Scott K.| last6 = Gorwitz| first6 = Rachel J.| last7 = Kaplan| first7 = Sheldon L.| last8 = Karchmer| first8 = Adolf W.| last9 = Levine| first9 = Donald P.| last10 = Murray| first10 = Barbara E.| last11 = J Rybak| first11 = Michael| last12 = Talan| first12 = David A.| last13 = Chambers| first13 = Henry F.| last14 = Infectious Diseases Society of America| title = Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children| journal = Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America| date = 2011-02-01| pmid = 21208910}}</ref><ref>{{Cite journal| doi = 10.1016/S0140-6736(09)61595-6| issn = 1474-547X| volume = 375| issue = 9717| pages = 846–855| last1 = Mathews| first1 = Catherine J.| last2 = Weston| first2 = Vivienne C.| last3 = Jones| first3 = Adrian| last4 = Field| first4 = Max| last5 = Coakley| first5 = Gerald| title = Bacterial septic arthritis in adults| journal = Lancet| date = 2010-03-06| pmid = 20206778}}</ref>
+==Antimicrobial Regimen – Empiric Therapy==
+{| class="wikitable"
+! style="width: 20%;" | '''Newborn (&lt; 1 week)'''
+! style="width: 20%;" | '''Newborn (1–4 weeks)'''
+! style="width: 20%;" | '''Infants (1–3 months)'''
+! style="width: 20%;" | '''Children (3 months–14 years)'''
+! style="width: 20%;" | '''Adults'''
+|-
+| valign = top |
+'''High Risk for MRSA'''
+* '''Preferred Regimen'''
+** [[Vancomycin]] 18 mg/kg/day IV q12h {{and}}
+** [[Cefotaxime]] 50 mg/kg IV q12h
+'''Low Risk for MRSA'''
+** [[Cefotaxime]] 50 mg/kg IV q12h {{and}}
+** [[Nafcillin]] 25 mg/kg IV q8h or [[Oxacillin]] 25 mg/kg IV q8h
+| valign = top |
+'''High Risk for MRSA'''
+* '''Preferred Regimen'''
+** [[Vancomycin]] 22 mg/kg/day IV q12h {{and}}
+** [[Cefotaxime]] 50 mg/kg IV q8h
+* '''Alternative Regimen'''
+** [[Clindamycin]] 5 mg/kg IV q8h
+'''Low Risk for MRSA'''
+* '''Preferred Regimen'''
+** [[Cefotaxime]] 50 mg/kg IV q8h {{and}}
+** [[Nafcillin]] 37 mg/kg IV q6h {{or}} [[Oxacillin]] 37 mg/kg IV q6h
+* '''Alternative Regimen'''
+** [[Clindamycin]] 5 mg/kg IV q6h
+| valign = top |
+'''High Risk for MRSA'''
+* '''Preferred Regimen'''
+** [[Vancomycin]] 40 mg/kg/day IV q6–8h {{and}}
+** [[Cefotaxime]] 50 mg/kg IV q8h
+'''Low Risk for MRSA'''
+* '''Preferred Regimen'''
+** [[Cefotaxime]] 50 mg/kg IV q8h {{and}}
+** [[Nafcillin]] 37 mg/kg IV q6h {{or}} [[Oxacillin]] 37 mg/kg IV q6h
+* '''Alternative Regimen'''
+** [[Clindamycin]] 7.5 mg/kg IV q6h
+| valign = top |
+'''Preferred Regimen'''
+* [[Vancomycin]] 40 mg/kg/day IV q6–8h {{and}}
+* [[Cefotaxime]] 50 mg/kg IV q8h
+| valign = top |
+'''Monoarticular'''
+* '''At risk for sexually-transmitted disease'''
+**'''Preferred Regimen'''
+*** [[Ceftriaxone]] 1 g IV q24h {{or}} [[Cefotaxime]] 1 g IV q8h {{or}} [[Ceftizoxime]] 1 g IV q8h
+**'''Alternative Regimen'''
+*** [[Vancomycin]] 1 g IV q12h
+* '''Not at risk for sexually-transmitted disease'''
+**'''Preferred Regimen'''
+*** [[Vancomycin]] 1 g IV q12h {{and}}
+*** [[Ceftriaxone]] 1 g IV q24h {{or}} [[Cefotaxime]] 1 g IV q8h {{or}} [[Ceftizoxime]] 1 g IV q8h
+**'''Alternative Regimen'''
+*** [[Vancomycin]] 1 g IV q12h {{and}}
+*** [[Ciprofloxacin]] 400 mg IV q12h {{or}} [[Levofloxacin]] 750 mg IV q 24 h
+'''Polyarticular'''
+*'''Preferred Regimen'''
+** [[Ceftriaxone]] 1 g IV q24h
+|}
+==Antimicrobial Regimen – Synovial Fluid Gram Stain-Based Therapy==
+{| border="1"
+! colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|'''Gram stain result'''}}
+!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|'''First choice antibiotic'''}}
+!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|'''Second choice antibiotic'''}}
+|-
+!Negative Gram stain
+|
+* [[Vancomycin]] 15–20 mg/kg q8–12h and
+* [[Ceftazidime]] 2 g IV q8h or [[Cefepime]] 2 g IV q8–12h
+|
+* [[Daptomycin]] 6-8 mg/kg IV q24h or [[Linezolid]] 600 mg IV/PO q12h
+and
+* [[Piperacillin-Tazobactam]] 4.5 g IV q6h or [[Aztreonam]] 2 g IV q8h or [[Imipenem]] 500 mg IV q6h or [[Meropenem]] 1 g IV q8h or [[Doripenem]] 500 mg IV q8h or [[Carbapenems]]
+|-
+!Gram-positive cocci
+|
+* [[Vancomycin]] 15–20 mg/kg q8–12h
+|
+* [[Daptomycin]] 6-8 mg/kg IV q24h or
+* [[Linezolid]] 600 mg IV/PO q12h
+|-
+!Gram-negative cocci
+| colspan="2" |
+* [[Ceftriaxone]] 1 g IV q24h or [[Cefotaxime]] 1 g IV q8h
+|-
+!Gram-negative bacilli
+|
+* [[Ceftazidime]] 2 g IV q8h or
+* [[Cefepime]] 2 g IV q8–12h or
+* [[Piperacillin-Tazobactam]] 4.5 g IV q6h
+|
+* [[Aztreonam]] 2 g IV q8h or
+* [[Imipenem]] 500 mg IV q6h or
+* [[Meropenem]] 1 g IV q8h or
+* [[Doripenem]] 500 mg IV q8h or
+|}
+==Antimicrobial Regimen – Pathogen Based Therapy==
+{| border="1"
+! colspan="2" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|'''Microorgnaism'''}}
+!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|'''First choice antibiotic'''}}
+!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|'''Second choice antibiotic'''}}
+|-
+! rowspan="2" |[[Staphylococcus aureus]]
+!Methicillin-sensitive
+|
+* [[Nafcillin]] 2 g IV QID or
+* [[Clindamycin]] 900 mg IV TID
+|
+* [[Cefazolin]] 0.25–1 g IV/IM q6–8h,
+* [[Vancomycin]] 500 mg IV q6h or 1 g IV q12h
+|-
+!Methicillin-resistant
+|
+* [[Vancomycin]]  15–20 mg/kg IV q8–12h in adults or 15 mg/kg IV q6h in children or
+* [[Linezolid]] 600 mg PO/IV q12h in adults or 10 mg/kg PO/IV q8h in children
+|
+* [[Sulfamethoxazole-Trimethoprim|Sulfamethoxazole-trimethoprim]] 3.5–4.0 mg/kg PO/IV q8–12h in adults or
+* [[Minocycline]] ± [[rifampin]]
+|-
+! rowspan="2" |[[Coagulase-negative Staphylococcus|Coagulase-negative Staphylococcus spp]]
+!Methicillin-sensitive
+|
+* [[Nafcillin]] 2 g IV QID or
+* [[Clindamycin]] 900 mg IV/IM TID
+|
+* [[Cefazolin]] 0.25–1 g IV/IM q6–8h
+* [[vancomycin]] 500 mg IV q6h or 1 g IV BD
+|-
+!Methicillin-resistant
+|
+* [[Vancomycin]] 1 g BD or
+* [[Linezolid]] 600 mg BD
+|
+* [[Sulfamethoxazole-Trimethoprim|Sulfamethoxazole-trimethoprim]] or
+* [[Minocycline]] ± [[rifampin]] or [[Clindamycin]]
+|-
+! colspan="2" |[[Group A streptococcus]], [[Streptococcal|Strep. pyogenes]]
+|
+* [[Penicillin]] G 2 million IV/IM every 4 h or
+* [[Ampicillin]] 2 g IV QID
+|
+* [[Clindamycin]] 600–1200 mg/day IV/IM q6–12h
+* [[Cefazolin]] 0.25–1 g IV/IM q6–8h
+|-
+! colspan="2" |[[Group B streptococcal infection|Group B streptococcus]], [[Streptococcus|Strep. agalactiae]]
+|
+* [[Penicillin]] G 2 million IV/IM every 4 h or
+* [[Ampicillin]] 2 g IV every 6 h
+|
+* [[Clindamycin]] 600–1200 mg/day IV/IM q6–12h
+* [[Cefazolin]] 0.25–1 g IV/IM q6–8h
+|-
+! colspan="2" |[[Enterococcus|Enterococcus spp]].
+|
+* [[Ampicillin]] 2 g IV QID or
+* [[Vancomycin]] 1 g IV  BD
+|
+* [[Ampicillin-Sulbactam|Ampicillin-sulbactam]] 3 g IV QID
+* [[Linezolid]] 600 mg PO/IV BD
+|-
+! colspan="2" |[[Escherichia coli]]
+|
+* [[Ampicillin-Sulbactam|Ampicillin-sulbactam]] 3 g IV QID
+|
+* [[Cefazolin]] 0.25–1 g IV/IM q6–8h, levofloxacin 500–750 mg IV/PO OD
+* [[Gentamicin]] 3–5 mg/kg/day IV q6–8h
+* [[Sulfamethoxazole-Trimethoprim|Sulfamethoxazole-trimethoprim]] 8–10 mg/kg/day IV/PO q6–12h
+|-
+! colspan="2" |[[Proteus mirabilis]]
+|
+* [[Ampicillin]] 2 g IV QID or
-Drainage or [[debridement]] of the joint space should always be performed in septic arthritis caused by [[MRSA]].  A 3- or 4-week course of therapy with '''[[Vancomycin]]''' (15–20 mg/kg/dose IV every 8–12 hours in adults or 15 mg/kg/dose IV every 6 hours in children), '''[[Daptomycin]]''' (6 mg/kg/day IV every 24 hours in adults or 6–10 mg/kg/dose IV every 24 hours in children), '''[[Linezolid]]''' (600 mg PO/IV twice daily in adults or 10 mg/kg/dose PO/IV every 8 hours in children), '''[[Clindamycin]]''' (600 mg PO/IV every 8 hours in adults or 10–13 mg/kg/dose PO/IV every 6–8 hours in children), and '''[[Trimethoprim-Sulfamethoxazole]]''' (3.5–4.0 mg/kg PO/IV every 8–12 hours in adults) have been used with success.  A prolonged treatment of 4 to 6 weeks may be required if the condition is complicated by [[osteomyelitis]].<ref>{{Cite journal| doi = 10.1093/cid/ciq146| issn = 1537-6591| volume = 52| issue = 3| pages = –18-55| last1 = Liu| first1 = Catherine| last2 = Bayer| first2 = Arnold| last3 = Cosgrove| first3 = Sara E.| last4 = Daum| first4 = Robert S.| last5 = Fridkin| first5 = Scott K.| last6 = Gorwitz| first6 = Rachel J.| last7 = Kaplan| first7 = Sheldon L.| last8 = Karchmer| first8 = Adolf W.| last9 = Levine| first9 = Donald P.| last10 = Murray| first10 = Barbara E.| last11 = J Rybak| first11 = Michael| last12 = Talan| first12 = David A.| last13 = Chambers| first13 = Henry F.| last14 = Infectious Diseases Society of America| title = Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children| journal = Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America| date = 2011-02-01| pmid = 21208910}}</ref><ref>{{Cite journal| doi = 10.1016/S0140-6736(09)61595-6| issn = 1474-547X| volume = 375| issue = 9717| pages = 846–855| last1 = Mathews| first1 = Catherine J.| last2 = Weston| first2 = Vivienne C.| last3 = Jones| first3 = Adrian| last4 = Field| first4 = Max| last5 = Coakley| first5 = Gerald| title = Bacterial septic arthritis in adults| journal = Lancet| date = 2010-03-06| pmid = 20206778}}</ref>
+* [[Levofloxacin]] 500 mg IV/PO OD
+|
+* [[Cefazolin]] 0.25–1 g IV/IM q6–8h
+* [[Sulfamethoxazole-Trimethoprim|Sulfamethoxazole-trimethoprim]] 8–10 mg/kg/day IV/PO q6–12h
+* [[Gentamicin]] 3–5 mg/kg/day IV q6–8h
+|-
+! colspan="2" |[[Proteus vulgaris]], [[Proteus|Proteus rettgeri]], [[Morganella morganii]]
+|
+* [[Cefotaxime]] 2 g IV  QID
-=====Prosthetic joint infection=====
+* [[Imipenem]] 500 mg IV  QID, or
-Management of prosthetic joint infection typically requires both surgical intervention and extended courses of antimicrobial therapy.  Options of surgical approach include debridement with retention of [[prosthesis]], two-stage procedure (removal of [[prosthesis]] and cement with [[debridement]] of infected tissue and placement of a joint spacer, followed by prolonged [[antibiotics]] and replacement of [[prosthesis]]), one-stage procedure (removal of [[prosthesis]], [[debridement]], and replacement of [[prosthesis]] in a single procedure), permanent resection [[arthroplasty]], and [[amputation]].  The surgical decision should be made by orthopedic surgeon with specialty consultation, such as infectious disease or plastic surgery as necessary.<ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref>
+* [[Levofloxacin]] 500 mg IV/PO OD
+|
+* [[Gentamicin]] 3–5 mg/kg/day IV q6–8h, or
+* [[Ticarcillin-Clavulanate|Ticarcillin-clavulanate]] 3.1 g IV q4–6h
+|-
+! colspan="2" |[[Serratia marcescens]]
+|
+* [[Cefotaxime]] 2 g IV QID
+|
+* [[Levofloxacin]] 500 mg IV/PO OD
+* [[Gentamicin]] 3–5 mg/kg/day IV q6–8h
+* [[Imipenem]] 500 mg IV QID
+|-
+! colspan="2" |[[Pseudomonas aeruginosa]]
+|
+* [[Cefepime]] 2 gm IV BD or
-Antibiotic selection and duration are determined according to the causative organisms and the surgical intervention performed.  Antimicrobial agent should achieve adequate tissue concentrations and be effective against slow-growing organisms and [[biofilms]]  in conformity with local antibiogram.  Liaison with microbiology services is recommended.  Empiric antibiotics may be required while culture results are pending and for the duration of treatment for culture-negative infection.  [[MRSA]] coverage with [[glycopeptide]] (e.g., [[Vancomycin]], [[Daptomycin]]) or [[Gram-negative]] coverage with [[Ceftriaxone]] should be considered when necessary.  Empiric or pathogen-directed antibiotic therapy is generally instituted following the procedure.<ref>{{Cite journal| issn = 1756-1833| volume = 338| pages = –1773| last1 = Matthews| first1 = Philippa C.| last2 = Berendt| first2 = Anthony R.| last3 = McNally| first3 = Martin A.| last4 = Byren| first4 = Ivor| title = Diagnosis and management of prosthetic joint infection| journal = BMJ (Clinical research ed.)| date = 2009| pmid = 19482869}}</ref>
+* [[Piperacillin]] 3 gm IV QID or
+* [[Imipenem]] 500 IV QID
+|
+* [[Ticarcillin-Clavulanate|Ticarcillin-clavulanate]] 3.1 g IV q4–6h
+* [[Tobramycin]] 3-5 mg/kg/day IV q6–8h
+* [[Amikacin]] 15 mg/kg/day IV/IM q8–12h
+* [[Ciprofloxacin]] 400 mg IV q8–12h
+|-
+! colspan="2" |[[Neisseria gonorrhoeae|Neisseria gonorrhea]]
+|
+* [[Ceftriaxone]] 2 g IV OD or
+* [[Cefotaxime]] 1 g TID
+|
+* [[Levofloxacin]] 500 mg IV/PO OD
+* [[Ampicillin]] 2 g IV QID
+|-
+! colspan="2" |[[Bacteroides fragilis]] group
+|
+* [[Clindamycin]] 900 mg IV/IM TID or
+* [[Metronidazole]] 500 mg TID
+|
+* [[Ampicillin-Sulbactam|Ampicillin-sulbactam]] 3 g IV QID or
+* [[Ticarcillin-Clavulanate|Ticarcillin-clavulanic acid]] 3.1 g IV QID
+|-
+! colspan="2" |[[Brucella melitensis]]
+|
+* [[Doxycycline]] 100 mg PO BD and [[Streptomycin]] 15 mg/kg IM QID or
-The duration of antibiotic treatment varies depending on the surgical procedure undertaken.  A six-week course of parenteral therapy is preferred if an infected [[prosthesis]] is retained, while two to four weeks of intravenous antibiotics may be sufficient if revision [[arthroplasty]] is performed.  Oral antibiotics are commonly prescribed for three to six months in the setting of retained [[prosthesis]] compared with six weeks for revision [[arthroplasty]].<ref>{{Cite journal| issn = 1756-1833| volume = 338| pages = –1773| last1 = Matthews| first1 = Philippa C.| last2 = Berendt| first2 = Anthony R.| last3 = McNally| first3 = Martin A.| last4 = Byren| first4 = Ivor| title = Diagnosis and management of prosthetic joint infection| journal = BMJ (Clinical research ed.)| date = 2009| pmid = 19482869}}</ref>
+* [[Rifampin]] 600–900 mg QID
+|
+* [[Doxycycline]] 100 mg PO BD and [[Gentamicin]] 5 mg/kg IV QID
+|-
+! colspan="2" |[[Haemophilus influenzae]]
+|
+* [[Amoxicillin-Clavulanate]] 875/125 mg PO BD or
+* [[Cefprozil]] 500 mg PO BD or
+* [[Cefuroxime]] 500 mg PO BD or
+* [[Cefdinir]] 600 mg PO OD
+|
+* [[Levofloxacin]] 750 mg IV/PO OD or
+* [[Moxifloxacin]] 400 mg IV/PO OD or
+* [[Clarithromycin]] 500 mg PO BD
+|-
+! colspan="2" |[[Morganella morganii]]
+|
+* [[Cefotaxime]] 2 g IV QID or
+* [[Imipenem]] 500 mg IV QID or
+* [[Levofloxacin]] 500 mg IV/PO OD
+|
+* [[Gentamicin]] 3–5 mg/kg/day IV q6–8h or
+* [[Ticarcillin-Clavulanate]] 3.1 g IV q4–6h
+|-
+! colspan="2" |[[Tropheryma whipplei]]
+|
+* [[Penicillin G]] 2 million units IV q4h for 2 weeks and [[Streptomycin]] 1 g IM/IV OD for 2 weeks, then [[TMP-SMX]] 160mg/800mg PO OD for 1 year
+|
+* [[Ceftriaxone]] 2 g IV OD, then [[TMP-SMX]] 160mg/800mg PO OD for 1 year
+|-
+! colspan="2" |[[Borrelia burgdorferi]]
+|
+* [[Amoxicillin]] 500 mg TID for 28 days or
+* [[Doxycycline]] 100 mg BD for 28 days or
+* [[Cefuroxime]] 500 mg BD for 28 days
+|
+* [[Azithromycin]] 500 mg PO OD for 7–10 days or
+* [[Clarithromycin]] 500 mg PO BD for 14–21 days or
+* [[Erythromycin]] 500 mg PO QID for 14–21 days
+|}
 ===Duration of Antimicrobial Therapy===
@@ Line 92: / Line 337: @@
 |}
-==Antimicrobial Regimen – Empiric Therapy==
+=== Prosthetic joint infection ===
+Management of prosthetic joint infection typically requires both surgical intervention and extended courses of antimicrobial therapy.  Options of surgical approach include
+* Debridement with retention of [[prosthesis|prosthesis:]]
+** Two-stage procedure (removal of [[prosthesis]] and cement with [[debridement]] of infected tissue and placement of a joint spacer, followed by prolonged [[antibiotics]] and replacement of [[prosthesis]])
+** One-stage procedure (removal of [[prosthesis]], [[debridement]], and replacement of [[prosthesis]] in a single procedure)
+* Permanent resection [[arthroplasty]] and [[amputation]].
+The surgical decision should be made by orthopedic surgeon with specialty consultation, such as infectious disease or plastic surgery as necessary.<ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref>
-===Newborn (&lt; 1 week)===
+Antibiotic selection and duration are determined according to the causative organisms and the surgical intervention performed.  Antimicrobial agent should achieve adequate tissue concentrations and be effective against slow-growing organisms and [[biofilms]]  in conformity with local antibiogram.  Liaison with microbiology services is recommended.  Empiric antibiotics may be required while culture results are pending and for the duration of treatment for culture-negative infection.  [[MRSA]] coverage with [[glycopeptide]] (e.g., [[Vancomycin]], [[Daptomycin]]) or [[Gram-negative]] coverage with [[Ceftriaxone]] should be considered when necessary.  Empiric or pathogen-directed antibiotic therapy is generally instituted following the procedure.<ref>{{Cite journal| issn = 1756-1833| volume = 338| pages = –1773| last1 = Matthews| first1 = Philippa C.| last2 = Berendt| first2 = Anthony R.| last3 = McNally| first3 = Martin A.| last4 = Byren| first4 = Ivor| title = Diagnosis and management of prosthetic joint infection| journal = BMJ (Clinical research ed.)| date = 2009| pmid = 19482869}}</ref>
-====High Risk for MRSA====
+The duration of antibiotic treatment varies depending on the surgical procedure undertaken.  A six-week course of parenteral therapy is preferred if an infected [[prosthesis]] is retained, while two to four weeks of intravenous antibiotics may be sufficient if revision [[arthroplasty]] is performed.  Oral antibiotics are commonly prescribed for three to six months in the setting of retained [[prosthesis]] compared with six weeks for revision [[arthroplasty]].<ref>{{Cite journal| issn = 1756-1833| volume = 338| pages = –1773| last1 = Matthews| first1 = Philippa C.| last2 = Berendt| first2 = Anthony R.| last3 = McNally| first3 = Martin A.| last4 = Byren| first4 = Ivor| title = Diagnosis and management of prosthetic joint infection| journal = BMJ (Clinical research ed.)| date = 2009| pmid = 19482869}}</ref>
-{{rx|Preferred Regimen}}
-* [[Vancomycin]] 18 mg/kg/day IV q12h {{and}}
-* [[Cefotaxime]] 50 mg/kg IV q12h
-</li>
-====Low Risk for MRSA====
-{{rx|Preferred Regimen}}
-* [[Cefotaxime]] 50 mg/kg IV q12h {{and}}
-* [[Nafcillin]] 25 mg/kg IV q8h {{or}} [[Oxacillin]] 25 mg/kg IV q8h
-</li>
-{{rx|Alternative Regimen}}
-* [[Clindamycin]] 5 mg/kg IV q8h
-</li>
-===Newborn (1–4 weeks)===
-====High Risk for MRSA====
-{{rx|Preferred Regimen}}
-* [[Vancomycin]] 22 mg/kg/day IV q12h {{and}}
-* [[Cefotaxime]] 50 mg/kg IV q8h
-</li>
-====Low Risk for MRSA====
-{{rx|Preferred Regimen}}
-* [[Cefotaxime]] 50 mg/kg IV q8h {{and}}
-* [[Nafcillin]] 37 mg/kg IV q6h {{or}} [[Oxacillin]] 37 mg/kg IV q6h
-</li>
-{{rx|Alternative Regimen}}
-* [[Clindamycin]] 5 mg/kg IV q6h
-</li>
-===Infants (1–3 months)===
-====High Risk for MRSA====
-{{rx|Preferred Regimen}}
-* [[Vancomycin]] 40 mg/kg/day IV q6–8h {{and}}
-* [[Cefotaxime]] 50 mg/kg IV q8h
-</li>
-====Low Risk for MRSA====
-{{rx|Preferred Regimen}}
-* [[Cefotaxime]] 50 mg/kg IV q8h {{and}}
-* [[Nafcillin]] 37 mg/kg IV q6h {{or}} [[Oxacillin]] 37 mg/kg IV q6h
-</li>
-{{rx|Alternative Regimen}}
-* [[Clindamycin]] 7.5 mg/kg IV q6h
-</li>
-===Children (3 months–14 years)===
-{{rx|Preferred Regimen}}
-* [[Vancomycin]] 40 mg/kg/day IV q6–8h {{and}}
-* [[Cefotaxime]] 50 mg/kg IV q8h
-</li>
-===Adults (Monoarticular)===
-====At risk for sexually-transmitted disease====
-{{rx|Preferred Regimen}}
-* [[Ceftriaxone]] 1 g IV q24h {{or}} [[Cefotaxime]] 1 g IV q8h {{or}} [[Ceftizoxime]] 1 g IV q8h
-</li>
-{{rx|Alternative Regimen}}
-* [[Vancomycin]] 1 g IV q12h
-</li>
-====Not at risk for sexually-transmitted disease====
-{{rx|Preferred Regimen}}
-* [[Vancomycin]] 1 g IV q12h {{and}}
-* [[Ceftriaxone]] 1 g IV q24h {{or}} [[Cefotaxime]] 1 g IV q8h {{or}} [[Ceftizoxime]] 1 g IV q8h
-</li>
-{{rx|Alternative Regimen}}
-* [[Vancomycin]] 1 g IV q12h {{and}}
-* [[Ciprofloxacin]] 400 mg IV q12h {{or}} [[Levofloxacin]] 750 mg IV q 24 h
-</li>
-===Adults (Polyarticular)===
-{{rx|Preferred Regimen}}
-* [[Ceftriaxone]] 1 g IV q24h
-</li>
-==Antimicrobial Regimen – Synovial Fluid Gram Stain-Based Therapy==
-===Negative Gram stain===
-{{rx|Preferred Regimen}}
-* [[Vancomycin]] 15–20 mg/kg q8–12h {{and}}
-* [[Ceftazidime]] 2 g IV q8h {{or}} [[Cefepime]] 2 g IV q8–12h
-</li>
-{{rx|Alternative Regimen}}
-* [[Daptomycin]] 6-8 mg/kg IV q24h {{or}} [[Linezolid]] 600 mg IV/PO q12h {{and}}
-* [[Piperacillin-Tazobactam]] 4.5 g IV q6h {{or}} [[Aztreonam]] 2 g IV q8h {{or}} [[Imipenem]] 500 mg IV q6h {{or}} [[Meropenem]] 1 g IV q8h {{or}} [[Doripenem]] 500 mg IV q8h {{or}} [[Carbapenems]]
-</li>
-===Gram-positive cocci===
-{{rx|Preferred Regimen}}
-* [[Vancomycin]] 15–20 mg/kg q8–12h
-</li>
-{{rx|Alternative Regimen}}
-* [[Daptomycin]] 6-8 mg/kg IV q24h {{or}} [[Linezolid]] 600 mg IV/PO q12h
-</li>
-===Gram-negative cocci===
-{{rx|Preferred Regimen}}
-* [[Ceftriaxone]] 1 g IV q24h {{or}} [[Cefotaxime]] 1 g IV q8h
-</li>
-===Gram-negative bacilli===
-{{rx|Preferred Regimen}}
-* [[Ceftazidime]] 2 g IV q8h {{or}} [[Cefepime]] 2 g IV q8–12h {{or}} [[Piperacillin-Tazobactam]] 4.5 g IV q6h
-</li>
-{{rx|Alternative Regimen}}
-* [[Aztreonam]] 2 g IV q8h {{or}} [[Imipenem]] 500 mg IV q6h {{or}} [[Meropenem]] 1 g IV q8h {{or}} [[Doripenem]] 500 mg IV q8h {{or}} [[Carbapenems]]
-</li>
-==Antimicrobial Regimen – Pathogen-Based Therapy==
-====Bacteroides fragilis====
-{{rx|Preferred Regimen}}
-* [[Clindamycin]] 900 mg IV/IM q8h {{or}} [[Metronidazole]] 500 mg IV q8
-</li>
-{{rx|Alternative Regimen}}
-* [[Ampicillin-Sulbactam]] 3 g IV q6h {{or}} [[Ticarcillin-Clavulanate]] 3.1 g IV q4–6h
-</li>
-====Brucella melitensis====
-{{rx|Preferred Regimen}}
-* [[Doxycycline]] 100 mg PO bid for ≥ 6 weeks {{and}}
-* [[Streptomycin]] 15 mg/kg IM qd for 2–3 weeks {{or}} [[Rifampin]] 600–900 mg qd for ≥ 6 weeks
-</li>
-{{rx|Alternative Regimen}}
-* [[Doxycycline]] 100 mg PO bid for ≥ 6 weeks {{and}}
-* [[Gentamicin]] 5 mg/kg IV qd for 7 days
-</li>
-====Enterococcus====
-{{rx|Preferred Regimen}}
-* [[Ampicillin]] 2 g IV q6h {{or}} [[Vancomycin]] 1 g IV q12h
-</li>
-{{rx|Alternative Regimen}}
-* [[Ampicillin-Sulbactam]] 3 g IV q6h {{or}} [[Linezolid]] 600 mg PO/IV q12h
-</li>
-====Escherichia coli====
-{{rx|Preferred Regimen}}
-* [[Ampicillin-Sulbactam]] 3 g IV q6h
-</li>
-{{rx|Alternative Regimen}}
-* [[Cefazolin]] 0.25–1 g IV/IM q6–8h {{or}} [[Levofloxacin]] 500–750 mg IV/PO q24h {{or}} [[Gentamicin]] 3–5 mg/kg/day IV q6–8h {{or}} [[TMP-SMX]] 8–10 mg/kg/day IV/PO q6–12h (TMP component)
-</li>
-====Haemophilus influenzae====
-{{rx|Preferred Regimen}}
-* [[Amoxicillin-Clavulanate]] 875/125 mg PO q12h {{or}} [[Cefprozil]] 500 mg PO q12h {{or}} [[Cefuroxime]] 500 mg PO q12h {{or}} [[Cefdinir]] 600 mg PO q24h
-</li>
-{{rx|Alternative Regimen}}
-* [[Levofloxacin]] 750 mg IV/PO q24h {{or}} [[Moxifloxacin]] 400 mg IV/PO q24h {{or}} [[Clarithromycin]] 500 mg PO q12h
-</li>
-====Morganella morganii====
-{{rx|Preferred Regimen}}
-* [[Cefotaxime]] 2 g IV q6h {{or}} [[Imipenem]] 500 mg IV q6h {{or}} [[Levofloxacin]] 500 mg IV/PO q24h
-</li>
-{{rx|Alternative Regimen}}
-* [[Gentamicin]] 3–5 mg/kg/day IV q6–8h {{or}} [[Ticarcillin-Clavulanate]] 3.1 g IV q4–6h
-</li>
-====Neisseria gonorrhoeae====
-{{rx|Preferred Regimen}}
-* [[Ceftriaxone]] 2 g IV q24h {{or}} [[Cefotaxime]] 1 g IV q8h
-</li>
-{{rx|Alternative Regimen}}
-* [[Levofloxacin]] 500 mg IV/PO q24h {{or}} [[Ampicillin]] 2 g IV q6h
-</li>
-====Proteus mirabilis====
-{{rx|Preferred Regimen}}
-* [[Ampicillin ]] 2 g IV q6h {{or}} [[Levofloxacin]] 500 mg IV/PO q24h
-</li>
-{{rx|Alternative Regimen}}
-* [[Cefazolin]] 0.25–1 g IV/IM q6–8h {{or}} [[Gentamicin]] 3–5 mg/kg/day IV q6–8h {{or}} [[TMP-SMX]] 8–10 mg/kg/day IV/PO q6–12h (TMP component)
-</li>
-====Proteus vulgaris or Proteus rettgeri====
-{{rx|Preferred Regimen}}
-* [[Cefotaxime]] 2 g IV q6h {{or}} [[Imipenem]] 500 mg IV q6h {{or}} [[Levofloxacin]] 500 mg IV/PO q24h
-</li>
-{{rx|Alternative Regimen}}
-* [[Gentamicin]] 3–5 mg/kg/day IV q6–8h {{or}} [[Ticarcillin-Clavulanate]] 3.1 g IV q4–6h
-</li>
-====Pseudomonas aeruginosa====
-{{rx|Preferred Regimen}}
-* [[Cefepime]] 2 g IV q12h  {{or}} [[Piperacillin]] 3–4 g IV q4–6h {{or}} [[Imipenem]] 500 mg IV q6h
-</li>
-{{rx|Alternative Regimen}}
-* [[Ticarcillin-Clavulanate]] 3.1 g IV q4–6h {{or}} [[Tobramycin]] 3-5 mg/kg/day IV q6–8h {{or}} [[Amikacin]] 15 mg/kg/day IV/IM q8–12h {{or}} [[Ciprofloxacin]] 400 mg IV q8–12h
-</li>
-====Serratia marcescens====
-{{rx|Preferred Regimen}}
-* [[Cefotaxime]] 2 g IV q6h
-</li>
-{{rx|Alternative Regimen}}
-* [[Levofloxacin]] 500 mg IV/PO q24h {{or}} [[Gentamicin]] 3–5 mg/kg/day IV q6–8h {{or}} [[Imipenem]] 500 mg IV q6h
-</li>
-====Staphylococcus aureus (methicillin-resistant)====
-{{rx|Preferred Regimen}}
-* [[Vancomycin]] 15–20 mg/kg IV q8–12h in adults or 15 mg/kg IV q6h in children
-</li>
-{{rx|Alternative Regimen}}
-* [[Daptomycin]] 6 mg/kg IV q24h in adults or 6–10 mg/kg IV q24h in children {{or}} [[Linezolid]] 600 mg PO/IV q12h in adults or 10 mg/kg PO/IV q8h in children {{or}} [[Clindamycin]] 600 mg PO/IV q8h in adults or 10–13 mg/kg/dose PO/IV q6–8h in children {{or}} [[TMP-SMX]] 3.5–4.0 mg/kg PO/IV q8–12h in adults
-</li>
-====Staphylococcus aureus (methicillin-susceptible)====
-{{rx|Preferred Regimen}}
-* [[Nafcillin]] 2 g IV q6h {{or}} [[Clindamycin]] 900 mg IV q8h
-</li>
-{{rx|Alternative Regimen}}
-* [[Cefazolin]] 0.25–1 g IV/IM q6–8h {{or}} [[Vancomycin]] 500 mg IV q6h or 1 g IV q12h
-</li>
-====Staphylococcus epidermidis (methicillin-resistant)====
-{{rx|Preferred Regimen}}
-* [[Vancomycin]] 500 mg IV q6h or 1 g IV q12h {{or}} [[Linezolid]] 600 mg IV q12h
-</li>
-{{rx|Alternative Regimen}}
-* [[TMP-SMX]] 3.5–4.0 mg/kg PO/IV q8–12h (TMP component) {{or}} [[Minocycline]] 200 mg PO x 1 dose, then 100 mg PO q12h {{and}}
-* [[Rifampin]] 300–600 mg PO/IV q12h
-</li>
-====Staphylococcus epidermidis (methicillin-susceptible)====
-{{rx|Preferred Regimen}}
-* [[Nafcillin]] 2 g IV q6h {{or}} [[Clindamycin]] 900 mg IV/IM q8h
-</li>
-{{rx|Alternative Regimen}}
-* [[Cefazolin]] 0.25–1 g IV/IM q6–8h {{or}} [[Vancomycin]] 500 mg IV q6h or 1 g IV q12h
-</li>
-====Streptococcus agalactiae====
-{{rx|Preferred Regimen}}
-* [[Penicillin G]] 2 MU IV/IM q4h {{or}} [[Ampicillin]] 2 g IV q6h
-</li>
-{{rx|Alternative Regimen}}
-* [[Clindamycin]] 600–1200 mg/day IV/IM q6–12h {{or}} [[Cefazolin]] 0.25–1 g IV/IM q6–8h
-</li>
-====Streptococcus pyogenes====
-{{rx|Preferred Regimen}}
-* [[Penicillin G]] 2 MU IV/IM q4h {{or}} [[Ampicillin]] 2 g IV q6h
-</li>
-{{rx|Alternative Regimen}}
-* [[Clindamycin]] 600–1200 mg/day IV/IM q6–12h {{or}} [[Cefazolin]] 0.25–1 g IV/IM q6–8h
-</li>
-====Tropheryma whipplei====
-{{rx|Preferred Regimen}}
-* [[Penicillin G]] 2 MU IV q4h for 2 weeks {{and}}
-* [[Streptomycin]] 1 g IM/IV q24h for 2 weeks, then [[TMP-SMX]] 160mg/800mg PO q24h for 1 year
-</li>
-{{rx|Alternative Regimen}}
-* [[Ceftriaxone]] 2 g IV q24h, then [[TMP-SMX]] 160mg/800mg PO q24h for 1 year
-</li>
-====Borrelia burgdorferi====
-{{rx|Preferred Regimen}}
-* [[Amoxicillin]] 500 mg q8h for 28 days {{or}} [[Doxycycline]] 100 mg q12h for 28 days {{or}} [[Cefuroxime]] 500 mg q12h for 28 days
-</li>
-{{rx|Alternative Regimen}}
-* [[Azithromycin]] 500 mg PO q24h for 7–10 days {{or}} [[Clarithromycin]] 500 mg PO q12h for 14–21 days {{or}} [[Erythromycin]] 500 mg PO q6h for 14–21 days
-</li>
-==Antimicrobial regimen==
-===Septic arthritis, Brucella melitensis===
-* Septic arthritis, Brucella melitensis <ref>{{cite book | last = Corbel | first = Michael | title = Brucellosis in humans and animals | publisher = World Health Organization | location = Geneva | year = 2006 | isbn = 9241547138 }}</ref>
-:* Preferred Regimen: [[Doxycycline]] 100 mg PO bid for ≥ 6 weeks {{and}} [[Streptomycin]] 15 mg/kg IM qd for 2–3 weeks {{or}} [[Rifampin]] 600–900 mg qd for ≥ 6 weeks
-:* Alternative Regimen: [[Doxycycline]] 100 mg PO bid for ≥ 6 weeks {{and}} [[Gentamicin]] 5 mg/kg IV qd for 7 days
-===Septic arthritis, candidal===
-* Septic arthritis, candidal <ref name="pmid19191635">{{cite journal| author=Pappas PG, Kauffman CA, Andes D, Benjamin DK, Calandra TF, Edwards JE et al.| title=Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2009 | volume= 48 | issue= 5 | pages= 503-35 | pmid=19191635 | doi=10.1086/596757 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19191635  }} </ref>
-:* Preferred regimen (1): [[Fluconazole]] 400 mg/day (6 mg/kg/day) for at least 6 weeks
-:* Preferred regimen (2): [[Amphotericin B]] 3–5 mg/kg/day for several weeks {{then}} [[Fluconazole]] to completion
-:* Alternative regimen (1): [[Anidulafungin]] 200-mg loading dose {{then}} 100 mg/day
-:* Alternative regimen (2): [[Caspofungin]] 70-mg loading dose {{then}} 50 mg/day
-:* Alternative regimen (3): [[Micafungin]] 100 mg/day
-:* Alternative regimen (4): [[Amphotericin B]] deoxycholate 0.5–1 mg/kg/day for several weeks {{then}} [[Fluconazole]] to completion
-:* Note: Duration of therapy usually is for at least 6 weeks, but few data are available; Surgical debridement is recommended for all cases; For infected prosthetic joints, removal is recommended for most cases.
-===Septic arthritis, gonococcal===
-* Septic arthritis, gonococcal <ref name="pmid12364368">{{cite journal| author=Shirtliff ME, Mader JT| title=Acute septic arthritis. | journal=Clin Microbiol Rev | year= 2002 | volume= 15 | issue= 4 | pages= 527-44 | pmid=12364368 | doi= | pmc=PMC126863 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12364368  }} </ref>
-:* Preferred regimen: [[Ceftriaxone]] 1 g intramuscularly IM/IV q24h
-:* Alternative regimen (1): [[Cefotaxime]] 1 g IV q8h
-:* Alternative regimen (2): [[Ceftizoxime]] 1 g IV q8h
-:* Alternative regimen (3): [[Spectinomycin]] 2 g IV q12h (Penicillin allergies)
-:* Alternative regimen (4): [[Ciprofloxacin]] 500 mg IV q12h {{or}} [[Ofloxacin]] 400 mg IV q12h (β-lactam-allergic patient)
-:* Note: The tetracyclines (except in pregnant women) or penicillins may be used if the infecting organism is proven to be susceptible
-:* Pediatric regimen:
-::* >45 kg
-:::* Preferred regimen: [[Ceftriaxone]] 50 mg/kg (Maximum, 2 g/dose) IM/IV single dose for 10 to 14 days
-::* <45 kg
-:::* Preferred regimen: [[Ceftriaxone]] 50 mg/kg (Maximum, 1 g/dose) IM/IV single dose for 7 days
-===Septic arthritis, Gram-negative  bacilli===
-* Septic arthritis, Gram-negative  bacilli <ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
-:* Preferred regimen (1): [[Ceftazidime]] 2 g IV q8h
-:* Preferred regimen (2): [[Cefepime]] 2 g IV q8–12h
-:* Preferred regimen (3): [[Piperacillin-Tazobactam]] 4.5 g IV q6h
-:* Alternative regimen (1): [[Aztreonam]] 2 g IV q8h
-:* Alternative regimen (2): [[Imipenem]] 500 mg IV q6h
-:* Alternative regimen (3): [[Meropenem]] 1 g IV q8h
-:* Alternative regimen (4): [[Doripenem]] 500 mg IV q8h
-:* Alternative regimen (5): [[Carbapenems]]
-===Septic arthritis, Histoplasmosis===
-* Septic arthritis, histoplasmosis<ref name="pmid17806045">{{cite journal| author=Wheat LJ, Freifeld AG, Kleiman MB, Baddley JW, McKinsey DS, Loyd JE et al.| title=Clinical practice guidelines for the management of patients with histoplasmosis: 2007 update by the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2007 | volume= 45 | issue= 7 | pages= 807-25 | pmid=17806045 | doi=10.1086/521259 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17806045  }}</ref>
-:*1. '''Mild disease'''
-::* Preferred regimen: [[Nonsteroidal anti-inflammatory drug]]
-:*2. '''Severe disease'''
-::* Preferred regimen: [[Prednisone]] 0.5–1.0 mg/kg/day (Maximum, 80 mg/day) in tapering doses over 1–2 weeks {{and}} [[Itraconazole]] 200 mg tid for 3 days, followed by qd or bid for 6–12 weeks
-===Septic arthritis, Lyme disease===
-* Septic arthritis, Lyme disease <ref name="pmid17029130">{{cite journal| author=Wormser GP, Dattwyler RJ, Shapiro ED, Halperin JJ, Steere AC, Klempner MS et al.| title=The clinical assessment, treatment, and prevention of lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2006 | volume= 43 | issue= 9 | pages= 1089-134 | pmid=17029130 | doi=10.1086/508667 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17029130  }} </ref>
-:*1. '''Patients without clinical evidence of neurologic disease'''
-::* Preferred regimen (1): [[Doxycycline]] 100 mg bid for 28 days
-::* Preferred regimen (2): [[Amoxicillin]] 500 mg tid for 28 days
-::* Preferred regimen (3): [[Cefuroxime axetil]] 500 mg bid for 28 days
-::* Pediatric regimen (1): [[Amoxicillin]] 50 mg/kg/day tid (Maximum, 500 mg/dose)
-::* Pediatric regimen (2): [[Cefuroxime axetil]] 30 mg/kg/day bid (Maximum, 500 mg/dose)
-::* Pediatric regimen (3): (if the patient is ≥8 years of age) [[Doxycycline]] 4 mg/kg/day bid (Maximum, 100 mg/dose)
-:*2. '''Patients with arthritis and objective evidence of neurologic disease'''
-::* Preferred regimen: [[Ceftriaxone]] administered parenterally for 2–4 weeks
-::* Alternative regimen: [[Cefotaxime]] {{or}} [[Penicillin G]] administered parenterally
-::* Pediatric regimen: [[Ceftriaxone]] {{or}} [[Cefotaxime]] {{or}} [[Penicillin G]] administered intravenously
-:* Note (1): For patients who have persistent or recurrent joint swelling after a recommended course of oral antibiotic therapy, we recommend re-treatment with another 4-week course of oral antibiotics or with a 2–4-week course of [[Ceftriaxone]] IV
-:* Note (2): If patients have no resolution of arthritis despite intravenous therapy and if PCR results for a sample of synovial fluid (and synovial tissue if available) are negative, symptomatic treatment is recommended, which consist of nonsteroidal anti-inflammatory agents, intra-articular injections of corticosteroids, or disease-modifying antirheumatic drugs (DMARDs), such as Hydroxychloroquine.
-===Septic arthritis, Mycobacterium  tuberculosis===
-* Septic arthritis, Mycobacterium  tuberculosis<ref>{{Cite book| edition = 4th| publisher = World Health Organization| isbn = 9789241547833| title = Treatment of Tuberculosis: Guidelines| location = Geneva| series = WHO Guidelines Approved by the Guidelines Review Committee| accessdate = 2015-06-08| date = 2010| url = http://www.ncbi.nlm.nih.gov/books/NBK138748/| pmid = 23741786}}</ref>
-:*1. '''Septic arthritis caused by susceptible Mycobacterium tuberculosis'''
-::*1.1 '''Adults'''
-:::*1.1.1 '''Intensive phase'''
-::::* Preferred regimen: [[Isoniazid]] 5 mg/kg (max, 300 mg) for 2 months {{and}} [[Rifampin]] 10 mg/kg (max: 600 mg) for 2 months {{and}} [[Pyrazinamide]] 15–30 mg/kg (max: 2 g) for 2 months {{and}} [[Ethambutol]] 15–20 mg/kg (max: 1 g) for 2 months
-:::*1.1.2 '''Continuation phase'''
-::::* Preferred regimen: [[Isoniazid]] 5 mg/kg (max: 300 mg) for 7 months {{and}} [[Rifampin]] 10 mg/kg (max: 600 mg) for 7 months
-::*1.2 '''Pediatric'''
-:::*1.2.1 '''Intensive phase'''
-::::* Preferred regimen: [[Isoniazid]] 10–15 mg/kg (max: 300 mg) for 2 months {{and}} [[Rifampin]] 10–20 mg/kg (max: 600 mg) for 2 months {{and}} [[Pyrazinamide]] 15–30 mg/kg (max: 2 g) for 2 months {{and}} [[Ethambutol]] 15–20 mg/kg (max: 1 g) for 2 months
-:::*1.2.2 '''Continuation phase'''
-::::* Preferred regimen: [[Isoniazid]] 10–15 mg/kg (max: 300 mg) for 7 months {{and}} [[Rifampin]] 10–20 mg/kg (max: 600 mg) for 7 months
-:*2. '''Specific considerations'''
-::*2.1 '''Pregnancy and breastfeeding'''
-:::* With the exception of streptomycin, the first line anti-TB drugs are safe for use in pregnancy: [[Streptomycin]] is ototoxic to the fetus and should not be used during pregnancy.
-:::* After active TB in the baby is ruled out, the baby should be given 6 months of isoniazid preventive therapy, followed by BCG vaccination.
-:::* Pyridoxine supplementation is recommended for all pregnant or breastfeeding women taking isoniazid.
-::*2.2 '''Liver disorders'''
-:::* Two hepatotoxic drugs (rather than the three in the standard regimen):
-::::* 9 months of [[Isoniazid]] {{and}} [[Rifampicin]] {{and}} [[Ethambutol]] (until or unless [[Isoniazid]] susceptibility is documented).
-::::* 2 months of [[Isoniazid]] {{and}} [[Rifampicin]] {{and}} [[Streptomycin]] {{and}} [[Ethambutol]], followed by 6 months of [[Isoniazid]] {{and}} [[Rifampicin]].
-::::* 6–9 months of [[Rifampicin]] {{and}} [[Pyrazinamide]] {{and}} [[Ethambutol]]
-:::* One hepatotoxic drug:
-::::* 2 months of [[Isoniazid]] {{and}} [[Ethambutol]] {{and}} [[Streptomycin]], followed by 10 months of [[Isoniazid]] {{and}} [[Ethambutol]]
-:::* No hepatotoxic drugs:
-::::* 18–24 months of [[Streptomycin]] {{and}} [[Ethambutol]] {{and}} a [[Fluoroquinolone]]
-::*2.3 '''Renal failure and severe renal insufficiency'''
-:::* The recommended initial TB treatment regimen for patients with renal failure or severe renal insufficiency is 2 months of [[Isoniazid]], [[Rifampicin]], [[Pyrazinamide]] and [[Ethambutol]], followed by 4 months of [[Isoniazid]] and [[Rifampicin]].
-:::* There is significant renal excretion of [[Ethambutol]] and metabolites of [[Pyrazinamide]], and doses should therefore be adjusted.
-:::* Three times per week administration of these two drugs at the following doses is recommended: [[Pyrazinamide]] (25 mg/kg), and [[Ethambutol]] (15 mg/kg)
-:::* While receiving [[Isoniazid]], patients with severe renal insufficiency or failure should also be given [[Pyridoxine]] in order to prevent peripheral [[neuropathy]].
-:::* Because of an increased risk of nephrotoxicity and ototoxicity, [[Streptomycin]] should be avoided in patients with renal failure. If [[Streptomycin]] must be used, the dosage is 15 mg/kg, two or three times per week, to a maximum of 1 gram per dose, and serum levels of the drug should be monitored.
-::*2.4 '''Previously treated patients in settings with rapid DST'''
-:::* TB patients whose treatment has failed or other patient groups with high likelihood of multidrug-resistant TB (MDR) should be started on an empirical MDR regimen.
-:::* TB patients returning after defaulting or relapsing from their first treatment course may receive the retreatment regimen containing first-line drugs 2HRZES/1HRZE/5HRE if country-specific data show low or medium levels of MDR in these patients or if such data are not available.
-::*2.5 '''TB treatment in people living with HIV'''
-:::* TB patients with known positive HIV status and all TB patients living in HIV prevalent settings should receive daily TB treatment at least during the intensive phase.
-:::* For the continuation phase, the optimal dosing frequency is also daily for these patients.
-:::* If a daily continuation phase is not possible for these patients, three times weekly dosing during the continuation phase is an acceptable alternative.
-:::* It is recommended that TB patients who are living with HIV should receive at least the same duration of TB treatment as HIV-negative TB patients.
-===Septic arthritis, pneumococcal===
-===Septic arthritis, post-intraarticular injection===
-* Septic arthritis, post-intraarticular injection <ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
-:* NO empiric therapy.
-===Septic arthritis, prosthetic joint infection===
-* Septic arthritis, prosthetic joint infection (device-related osteoarticular infections) <ref name="pmid23230301">{{cite journal| author=Osmon DR, Berbari EF, Berendt AR, Lew D, Zimmerli W, Steckelberg JM et al.| title=Executive summary: diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2013 | volume= 56 | issue= 1 | pages= 1-10 | pmid=23230301 | doi=10.1093/cid/cis966 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23230301  }} </ref>
-:*1. '''Empiric antimicrobial therapy'''
-::* It is preferable to delay antibiotic therapy until specimens for culture are obtained by joint aspiration, joint debridement, and/or prosthesis removal.
-:*2. '''Pathogen-directed antimicrobial therapy'''
-::*2.1 '''Staphylococcus aureus, methicillin-susceptible (MSSA)'''
-:::* Preferred regimen (1): [[Nafcillin]] 2 g IV q4–6h
-:::* Preferred regimen (2): [[Oxacillin]] 2 g IV q4–6h
-:::* Alternative regimen (1): [[Cefazolin]] 1–2 g IV q8h
-:::* Alternative regimen (2): [[Ceftriaxone]] 2 g IV q24h
-:::* Alternative regimen (3): (if allergic to penicillins) [[Clindamycin]] 900 mg IV q8h
-:::* Alternative regimen (4): (if allergic to penicillins) [[Vancomycin]] 15–20 mg/kg IV q8–12h (Maximum, 2 g/dose)
-::*2.2 '''Staphylococcus, methicillin-resistant (MRSA)'''
-:::*2.2.1 '''Early-onset or acute hematogenous prosthetic joint infections involving a stable implant with short duration (< 3 weeks) of symptoms and debridement (but device retention)'''
-::::* Preferred regimen: [[Vancomycin]] {{and}} [[Rifampin]] 600 mg PO qd or 300–450 mg PO bid for 2 weeks
-::::* Alternative regimen: ([[Daptomycin]] 6 mg/kg IV q24h {{or}} [[Linezolid]] 600 IV q8h) {{and}} [[Rifampin]] 600 mg PO qd or 300–450 mg PO bid for 2 weeks
-::::* Note: The above regimen should be followed by [[Rifampin]] plus a fluoroquinolone, TMP/SMX, a tetracycline or [[Clindamycin]] for 3 or 6 months for hips and knees, respectively.
-:::*2.2.2 '''Early-onset spinal implant infections or implants in an actively infected site'''
-::::* Initial parenteral therapy plus [[Rifampin]] followed by prolonged oral therapy is recommended.
-::::* Long-term oral suppressive antibiotics (eg, TMP-SMX, a tetracycline, a fluoroquinolone [which should be given in conjunction with [[Rifampin]] due to the potential emergence of fluoroquinolone resistance)
-::*2.3 '''Streptococci, beta-hemolytic'''
-:::* Preferred regimen (1): [[Penicillin]] 12–18 MU/day IV q6h
-:::* Preferred regimen (2): [[Ampicillin]] 2 g IV q6h
-:::* Preferred regimen (3): [[Ceftriaxone]] 1–2 g IV q24h
-:::* Alternative regimen (1): (if allergic to penicillins) [[Clindamycin]] 900 mg IV q8h
-:::* Alternative regimen (2): (if allergic to penicillins) [[Vancomycin]] 15–20 mg/kg IV q8–12h (Maximum, 2 g/dose)
-::*2.4 '''Enterococci'''
-:::*2.4.1 '''Monotherapy'''
-::::* Preferred regimen (1): [[Ampicillin]] 6-12 g/day q4-6h
-::::* Preferred regimen (2): [[Penicillin G]] 18-30 MU/day continuously or q4h
-::::* Preferred regimen (3): [[Vancomycin]] 15-20 mg/kg/dose q8-12h (Maximum, 2 g/dose)
-:::*2.4.2 '''Combination therapy (one of the monotherapy agents, and one of the following agents)'''
-::::* Preferred regimen (1): [[Gentamicin]] 1 mg/kg IV q8h
-::::* Preferred regimen (2): [[Streptomycin]] 7.5 mg/kg IV q12h
-::::* Preferred regimen (3): [[Ampicillin]] 2 g/day IV q6h {{and}} [[Ceftriaxone]] 2 g IV q12h
-::*2.5 '''Gram-negative bacilli'''
-:::* Patients susceptible to fluoroquinolones
-::::* Preferred regimen: [[Ciprofloxacin]] 500-750 mg bid
-:::*2.5.1 '''P. aeruginosa'''
-::::* Preferred regimen (1): [[Cefepime]] 2 g IV q12h
-::::* Preferred regimen (2): [[Meropenem]] 1 g IV q8h
-::::* Alternative regimen (1): [[Ciprofloxacin]] 750 mg PO bid
-::::* Alternative regimen (2): [[Ceftazidime]] 2 g IV q8h
-::*2.6 '''Anaerobes'''
-:::*2.6.1'''Propionibacterium acnes'''
-::::* Preferred regimen (1): [[Penicillin]] 24 MU/day IV q4h or continuously
-::::* Preferred regimen (2): [[Ceftriaxone]] 1-2 g/day IV
-::::* Alternative regimen: [[Vancomycin]] {{or}} [[Clindamycin]]
-:::*2.6.2 '''Not Propionibacterium acnes'''
-:::* Preferred regimen: [[Metronidazole]] 500 mg PO tid
-::*2.7 '''Mycobacterium tuberculosis'''
-:::* Preferred regimen: see (Septic arthritis, Mycobacterium tuberculosis)
-::*2.8 '''Fungi'''
-:::* Preferred regimen: see (Septic arthritis, candidal)
-::*2.9 '''Culture negative'''
-:::* Preferred regimen:  [[Vancomycin]] {{and}} [[Ciprofloxacin]] {{or}} [[Cefazolin]] {{and}} [[Ciprofloxacin]]
-===Septic arthritis, staphylococcal===
-.'''Staphylococcus aureus (methicillin-resistant)'''<ref name="pmid21208910">{{cite journal| author=Liu C, Bayer A, Cosgrove SE, Daum RS, Fridkin SK, Gorwitz RJ et al.| title=Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children. | journal=Clin Infect Dis | year= 2011 | volume= 52 | issue= 3 | pages= e18-55 | pmid=21208910 | doi=10.1093/cid/ciq146 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21208910  }} </ref><ref name="pmid23591823">{{cite journal| author=Sharff KA, Richards EP, Townes JM| title=Clinical management of septic arthritis. | journal=Curr Rheumatol Rep | year= 2013 | volume= 15 | issue= 6 | pages= 332 | pmid=23591823 | doi=10.1007/s11926-013-0332-4 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23591823  }} </ref><ref name=name of the journal>{{cite web | title = topic name and journal name| url =http://www.uptodate.com/contents/septic-arthritis-in-adults?source=search_result&search=Septic+arthritis&selectedTitle=1~150#H18 }}</ref>
-:* Preferred regime: [[Vancomycin]] 15–20 mg/kg IV q8–12h
-:* Alternative regimen (1): [[Daptomycin]] 6 mg/kg IV q24h
-:* Alternative regimen (2): [[Linezolid]] 600 mg PO/IV q12h
-:* Alternative regimen (3): [[Clindamycin]] 600 mg PO/IV q8h
-:* Alternative regimen (4): [[TMP-SMX]] 3.5–4.0 mg/kg PO/IV q8–12h
-:* Pediatric regimen（1): [[Vancomycin]] 15 mg/kg IV q6h
-:* Pediatric regimen（1): [[Daptomycin]] 6–10 mg/kg IV q24h
-:* Pediatric regimen（1): [[Linezolid]] 10 mg/kg PO/IV q8h
-:* Pediatric regimen（1): [[Clindamycin]] 10–13 mg/kg/dose PO/IV q6–8h
-. '''Staphylococcus aureus (methicillin-susceptible)'''
-:* Preferred regimen (1): [[Nafcillin]] 2 g IV q6h
-:* Preferred regimen (2): [[Clindamycin]] 900 mg IV q8h
-:* Alternative regimen (1): [[Cefazolin]] 0.25–1 g IV/IM q6–8h
-:* Alternative regimen (2): [[Vancomycin]] 500 mg IV q6h or 1 g IV q12h
-. '''Staphylococcus epidermidis (methicillin-resistant)'''
-:* Preferred regimen (1): [[Vancomycin]] 500 mg IV q6h or 1 g IV q12h
-:* Preferred regimen (2): [[Linezolid]] 600 mg IV q12h
-:* Alternative regimen: (TMP-SMX 3.5–4.0 mg/kg PO/IV q8–12h (TMP component) {{or}} [[Minocycline]] 200 mg PO single dose {{then}} 100 mg PO q12h) {{and}} [[Rifampin]] 300–600 mg PO/IV q12h
-. '''Staphylococcus epidermidis (methicillin-susceptible)'''
-:* Preferred regimen (1): [[Nafcillin]] 2 g IV q6h
-:* Preferred regimen (2): [[Clindamycin]] 900 mg IV q8h
-:* Alternative regimen (1): [[Cefazolin]] 0.25–1 g IV/IM q6–8h
-:* Alternative regimen (2): [[Vancomycin]] 500 mg IV q6h or 1 g IV q12h
-===Septic arthritis, streptococcal===
-. '''Streptococcus agalactiae''' <ref>{{cite web | title = Clinical Management of Septic Arthritis| url =http://www.med.unc.edu/tarc/events/event-files/septic%20arthritis%20management.pdf }}</ref>
-:* Preferred regimen (1): [[Penicillin G]] 2 MU IV/IM q4h
-:* Preferred regimen (2): [[Ampicillin]] 2 g IV q6h
-:* Alternative regimen (1): [[Clindamycin]] 600–1200 mg/day IV/IM q6–12h
-:* Alternative regimen (2): [[Cefazolin]] 0.25–1 g IV/IM q6–8h
-. '''Streptococcus pyogenes'''
-:* Preferred regimen (1): [[Penicillin G]] 2 MU IV/IM q4h
-:* Preferred regimen (2): [[Ampicillin]] 2 g IV q6h
-:* Alternative regimen (1): [[Clindamycin]] 600–1200 mg/day IV/IM q6–12h
-:* Alternative regimen (2): [[Cefazolin]] 0.25–1 g IV/IM q6–8h
 ==References==
@@ Line 608: / Line 355: @@
 [[Category:Disease]]
 [[Category:Emergency medicine]]
-[[Category:Infectious disease]]
 [[Category:Medical emergencies]]
 [[Category:Rheumatology]]
 [[Category:Infectious Disease Project]]
+[[Category:Emergency mdicine]]
+[[Category:Up-To-Date]]
+[[Category:Infectious disease]]
+[[Category:Orthopedics]]