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 group | Possible organisms | No known drug allergies | Penicillin allergy (non-severe eg rash) | Penicillin allergy (severe eg anaphylaxis) |
| No specific risk factors | Staphylococcus spp, beta-haemolytic streptococci | IV flucloxacillin | IV anti-staphylococcal cephalosporin (eg cefuroxime) | Clindamycin |
| Frail, recurrent UTIs, end-stage renal failure, recent abdominal surgery? | Aerobic Gram-negative rods | IV co-amoxiclav | IV 3rd generation cephalosporin (eg ceftriaxone) | Clindamycin plus ciprofloxacin |
| MRSA risk | Meticillin-resistant S aureus | Add IV glycopeptidea | Add IV glycopeptidea | Add IV glycopeptidea |
| Suspected gonococcal septic arthritis 18 ,b | Neisseria gonorrhoeae | IV 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, Fungal | IV flucloxacillin | IV anti-staphylococcal cephalosporin (eg cefuroxime) | Clindamycin |
| Known colonised with multidrug resistant organism | ||||
| MRSA, ESBL, CPE etc | Discuss 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