Table 1.

Suggested empiric antibiotics for native joint septic arthritis in adults (but consult local guidelines). Modify, with microbiological advice, when culture results are available

Suggested empiric antibiotic choice (after blood cultures and joint aspirate)
Patient groupPossible organismsNo known drug allergiesPenicillin allergy (non-severe eg rash)Penicillin allergy (severe eg anaphylaxis)
No specific risk factors Staphylococcus spp, beta-haemolytic streptococciIV flucloxacillinIV anti-staphylococcal cephalosporin (eg cefuroxime)Clindamycin
Frail, recurrent UTIs, end-stage renal failure, recent abdominal surgery?Aerobic Gram-negative rodsIV co-amoxiclavIV 3rd generation cephalosporin (eg ceftriaxone)Clindamycin plus ciprofloxacin
MRSA riskMeticillin-resistant S aureusAdd IV glycopeptideaAdd IV glycopeptideaAdd IV glycopeptidea
Suspected gonococcal septic arthritis 18 ,b Neisseria gonorrhoeaeIV 3rd generation cephalosporin (eg ceftriaxone)IV 3rd generation cephalosporin (eg ceftriaxone)Clindamycin plus ciprofloxacin (stop clindamycin if proven Neisseria infection)
Intravenous drug usage S aureus. Less likely Pseudomonas aeruginosa, FungalIV flucloxacillinIV anti-staphylococcal cephalosporin (eg cefuroxime)Clindamycin
Known colonised with multidrug resistant organism
MRSA, ESBL, CPE etcDiscuss with microbiology
  • Table adapted from 3,4

  • aGlycopeptides include vancomycin and teicoplanin. These should be used at high doses in bone and joint infection ie vancomycin at 10–12 mg/kg and teicoplanin at 10 mg/kg. Modifications to dosing will need to be made in the setting of low body weight and/or impaired renal function.

  • bConsult local infectious diseases / micro or genitourinary medicine physicians

  • ESBL = extended-spectrum beta-lactamases; CPE = carbapenemase-producing enterobacteriaceae; IV = intravenous; MRSA = Meticillin-resistant Staphylococcus aureus