The treatment for septic arthritis requires an adequate drainage of purulent joint fluid and appropriate antimicrobial therapy.
Empiric therapy should be started after the collection joint fluid and blood sample, and these should be send for culture.
Empiric Therapy Adapted from Lancet 375:846, 2010. [1]
▸ Click on the following categories to expand treatment regimens.
▸ Children (3 mo - 14 yr)
Infants (1- 3 months)
Preferred Regimen
High suspicion of MRSA
▸ Vancomycin 40 mg/kg/day divided q6-8h
PLUS
▸ Cefotaxime 50 mg/kg IV q8h
Low suspicion of MRSA
▸ Nafcillin 37 mg/kg q6h (max 8-12 g/day) OR ▸ Oxacillin 37 mg/kg q6h (max 8-12 g/day)
PLUS
▸ Cefotaxime 50 mg/kg IV q8h
Alternative Regimen
▸ Clindamycin 7.5mg/kg q6h
Chronic Monoarticular
Empirical therapy is not recommended. Treatment should be addressed for the specific etiology
Polyarticular
Preferred Regimen
▸ Ceftriaxone 1 gm IV q24h
CSF Gram Stain-Based Therapy Adapted from
▸ Click on the following categories to expand treatment regimens.
Gram-Positive Cocci
Preferred Regimen
▸ Vancomycin 15-20 mg/kg IV q8—12h (trough 15—20 μg/mL)
Alternative Regimen (For patients allergic to vancomycin)
▸ Linezolid OR ▸ Daptomycin
Gram-Negative Cocci
Preferred Regimen
▸ Ceftriaxone 1 g IV q24h
Pathogen-Based Therapy — Bacteria Adapted from
▸ Click on the following categories to expand treatment regimens.
▸ Staphylococcus epidermidis
▸ Methicillin-resistant S. aureus
▸ Streptococcus groups A, B, C, G
▸ Mycobacterium tuberculosis
Staphylococcus epidermidis
Preferred Regimen
▸ Nafcillin 1.5-2 g IV q4h OR ▸ Oxacillin 1.5-2 g IV q4h OR ▸ Cefazolin 1 g IV q8h
Alternative Regimen Methicillin-resistant
▸ Vancomycin 15-20 mg/kg IV q8h |}
Methicillin-resistant S. aureus
Preferred Regimen
▸ Vancomycin 15 mg/kg IV q12h
Alternative Regimen
▸ Linezolid 600 mg IV/PO q12h
Streptococcus groups A, B, C, G
Preferred Regimen
▸ Penicillin G 20 MU IV q24h or divided in 6 doses/day OR ▸ Ceftriaxone 2 g IV or IM q24h OR ▸ Cefazolin 1 g IV q8h
Alternative Regimen
▸ Vancomycin 15mg/kg IV q12h
Neisseria gonorrhoeae
Preferred Regimen
▸ Ceftriaxone 1 g IV q24h for 1-2 days after clinical improvement
FOLLOWED BY
▸ Cefixime 400 mg po q12h for 1 week OR ▸ Ciprofloxacin 500 mg po q12h for 1 week OR ▸ Ofloxacin 400 mg PO q12h for 1 week
Alternative Regimen
▸ Ciprofloxacin 400 mg IV q12h for 1-2 days after clinical improvement OR ▸ Ofloxacin 400 mg iv q12h for 1-2 days after clinical improvement OR ▸ Spectinomycin 2 g IM q12h for 1-2 days after clinical improvement
FOLLOWED BY
▸ Ciprofloxacin 500 mg po q12h for 1 week OR ▸ Ofloxacin 400 mg po q12h for 1 week
Haemophilus influenzae
Preferred Regimen
▸ [[
Alternative Regimen
▸ [[ OR ▸ [[
Borrelia burgdorferi
Preferred Regimen
▸ [[
Alternative Regimen
▸ [[ OR ▸ [[
Treponema pallidum
Preferred Regimen
▸ [[
Alternative Regimen
▸ [[ OR ▸ [[
T. whipplei
Preferred Regimen
▸ [[
Alternative Regimen
▸ [[ OR ▸ [[
Nocardia
Preferred Regimen
▸ [[
Alternative Regimen
▸ [[ OR ▸ [[
Pathogen-Based Therapy — Fungi
▸ Click on the following categories to expand treatment regimens.
Candida
Preferred Regimen
▸ Amphotericin B deoxycholate 0.5-1 mg/kg/day for 2-3 weeks
FOLLOWED BY
▸ Fluconazole to complete a total duration of therapy of 6-12 months.
Preferred Regimen
▸ Itraconazole 400 mg/day for at least 12 months
Pathogen-Based Therapy in Patients with Prosthetic Joint — Bacteria Adapted from Diagnosis and Management of Prosthetic Joint Infection CID 2013:56[2]
▸ Click on the following categories to expand treatment regimens.
▸ Staphylococci, oxacillin-susceptible
▸ Staphylococci, oxacillin-resistant
▸ Enterococcus spp, penicillin-susceptible
▸ Enterococcus spp, penicillin-resistant
Staphylococci, oxacillin-resistant
Preferred Regimen
▸ Vancomycin 15 mg/kg IV q12h
Alternative Regimen
▸ Daptomycin 6 mg/kg IV q24h OR ▸ Linezolid 600 mg PO/IV q12h
Enterococcus spp, penicillin-susceptible
Preferred Regimen
▸ Penicillin G 20-40 MU IV q24h continuously or divided in 6 doses
Alternative Regimen
▸ Vancomycin IV 15 mg/kg q12h OR ▸ Daptomycin 6 mg/kg IV q24h OR ▸ Linezolid 600 mg PO/IV q12h
Enterococcus spp, penicillin-resistant
Preferred Regimen
▸ Vancomycin IV 15 mg/kg q12h
Alternative Regimen
▸ Daptomycin 6 mg/kg IV q24h OR ▸ Linezolid 600 mg PO/IV q12h
Enterobacter spp
Preferred Regimen
▸ Cefepime 2 g IV q12h OR ▸ Ertapenem 1 g IV q24 h
Alternative Regimen
▸ Ciprofloxacin 750 mg PO q12h or 400 mg IV q12h
Preferred Regimen
▸ [[
Alternative Regimen
▸ [
↑ . doi :10.1016/S0140-6736(09)61595-6. .
↑ Osmon, D. R.; Berbari, E. F.; Berendt, A. R.; Lew, D.; Zimmerli, W.; Steckelberg, J. M.; Rao, N.; Hanssen, A.; Wilson, W. R. (2012). "Diagnosis and Management of Prosthetic Joint Infection: Clinical Practice Guidelines by the Infectious Diseases Society of America". Clinical Infectious Diseases . 56 (1): e1–e25. doi :10.1093/cid/cis803 . ISSN 1058-4838 .