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{{Septic arthritis}}
{{Septic arthritis}}
{{CMG}}; '''Associate Editor(s)-In-Chief:''' Jumana Nagarwala, M.D., ''Senior Staff Physician, Department of Emergency Medicine, Henry Ford Hospital''; {{CZ}}
{{CMG}}; '''Associate Editor(s)-In-Chief:''' {{AL}}; Jumana Nagarwala, M.D., ''Senior Staff Physician, Department of Emergency Medicine, Henry Ford Hospital''; {{CZ}}


==Overview==
==Overview==

Revision as of 15:33, 5 September 2014

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Alejandro Lemor, M.D. [2]; Jumana Nagarwala, M.D., Senior Staff Physician, Department of Emergency Medicine, Henry Ford Hospital; Cafer Zorkun, M.D., Ph.D. [3]

Overview

The treatment for septic arthritis requires an adequate drainage of the joint fluid and appropriate antibiotic therapy. Empiric therapy should be started after the collection joint fluid and blood sample for culture. There are no indications for intra-articular antibiotic therapy.

Medical Therapy

Antibiotics are used to treat the infection and most of them achieve excellent bactericidal concentrations in the synovial fluid. The initial therapy depends on the clinical presentation, whether the patient is at risk for a Gonoccocal infection or not, and Gram stain of joint aspiration. The final therapy depends on the culture and sensitivity results. During the acute phase of the disease is important to keep the the joint still and raised, and the patient need to rest. Using cool compresses may help relieve pain. After the acute phase, exercise and physical therapy is important for the recovery process. Severe cases may need surgery to drain the infected joint fluid.

Duration of Antimicrobial Therapy

  • The duration of antimicrobial therapy should be individualized in accordance with patient's clinical response.
Recommended Duration of Antimicrobial Therapy Based on Isolated Pathogen.
Microorganism Duration of Therapy
 ▸ Staphylococcus aureus 3-4 weeks
 ▸ Streptococcus groups A, B, C, G 3-4 weeks
 ▸ Gram-negative bacilli 4 weeks
 ▸ Brucella 6 weeks
 ▸ Borrelia burgdorferi 30 days
 ▸ Mycobacterium tuberculosis 9 months
 ▸ Candida albicans 6 weeks


Special cases Duration of Therapy
 ▸ Prosthetic joint infection 6 weeks
 ▸ Post intra-articular injection or post-arthroscopy infection 14 days

Empiric Therapy Adapted from Lancet 375:846, 2010.[1]

▸ Click on the following categories to expand treatment regimens.

    Pediatric

    Newborns (< 1 week)

  ▸  Newborns (1 -4 week)

  ▸  Infants (1 - 3 months)

  ▸  Children (3 mo - 14 yr)

    Adults

  ▸  Acute Monoarticular

  ▸  Chronic Monoarticular

  ▸  Polyarticular

Newborn (< 1 week)
Preferred Regimen
High suspicion of MRSA
Vancomycin 18 mg/kg IV divided q12h
PLUS
Cefotaxime 50 mg/kg IV q12h
Low suspicion of MRSA
Nafcillin 25 mg/kg q8h
OR
Oxacillin 25 mg/kg q8h
PLUS
Cefotaxime 50 mg/kg IV q12h
Alternative Regimen
(For low suspicion of MRSA)
Clindamycin 5mg/kg q8h
Newborn (1 - 4 weeks)
Preferred Regimen
High suspicion of MRSA
Vancomycin 22 mg/kg q12h
PLUS
Cefotaxime 50 mg/kg IV q8h
Low suspicion of MRSA
Nafcillin 37 mg/kg q6h
OR
Oxacillin 37 mg/kg q6h
PLUS
Cefotaxime 50 mg/kg IV q8h
Alternative Regimen
(For low suspicion of MRSA)
Clindamycin 5mg/kg q6h
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
(For low suspicion of MRSA)
Clindamycin 7.5mg/kg q6h
Children (3 mo - 14 yr)
Preferred Regimen
Vancomycin 40 mg/kg/day IV q6-8h
PLUS
Cefotaxime 50 mg/kg IV q8h
Alternative Regimen
Linezolid 10 mg/kg IV q8h
OR
Clindamycin 7.5 mg/kg IV q6h
PLUS
Aztreonam 30 mg/kg IV q6h
Acute Monoarticular
Preferred Regimen
At risk for Gonococcal infection
Ceftriaxone 1 g IV q24h
OR
Cefotaxime 1 g IV q8h
OR
Ceftizoxime 1 g IV q8h
Not at risk for Gonococcal infection
Vancomycin 15-20 mg/kg IV q8-12h
PLUS
Ceftriaxone 1g IV q24h
OR
Cefepime 2g IV q8h
Alternative Regimen
(If not at risk for Gonococcal infection)
Vancomycin 15-20 mg/kg IV q8-12h
PLUS
Ciprofloxacin 400 mg IV q12h
OR
Levofloxacin 750 mg IV q24h
Chronic Monoarticular
Empirical therapy is not recommended.
Treatment should be addressed for the specific etiology
Polyarticular
Preferred Regimen
Ceftriaxone 1 gm IV q24h

Synovial Fluid Gram Stain-Based Therapy Adapted from Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases[2]

▸ Click on the following categories to expand treatment regimens.

Gram-Positive

  ▸  Gram-Positive Cocci

  ▸  Gram-Positive Bacilli

Gram-Negative

  ▸  Gram-Negative Cocci

  ▸  Gram-Negative Rods

Negative Gram Stain

  ▸  Negative Gram Stain

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 600 mg PO/IV q12h
OR
Daptomycin 6 mg/kg IV q24h
Gram-Positive Bacilli
Preferred Regimen
Penicillin G 2 MU IV q4h
Alternative Regimen
Vancomycin 15-20 mg/kg IV q8—12h (trough 15—20 μg/mL)
OR
Nafcillin 1.5-2 g IV q4h
Gram-Negative Cocci
Preferred Regimen
Ceftriaxone 1 g IV q24h
Gram-Negative Rods
Preferred Regimen
Ceftazidime 2 g IV q8h
OR
Cefepime 2g IV q12h
OR

Piperacillin-tazobactam 4.5 g q6h
OR
Imipenem 500 mg IV q6h
OR
Meropenem 1 g IV q8h

Alternative Regimen (For patients allergic to cephalosporins)
Aztreonam 2 g q8h
OR
Ciprofloxacin 400 mg IV q12h
OR
Levofloxacin 750 mg IV q24h
Negative Gram Stain
Preferred Regimen
Vancomycin 15-20 mg/kg IV q8—12h
PLUS
Ceftazidime 2 g IV q8h
Alternative Regimen
Ciprofloxacin 750 mg IV q12h
OR
Levofloxacin 750 mg IV q24h
OR
Tobramycin 300mg q12h
OR
Gentamycin 5-7 mg/kg once daily or 5 mg/kg divided in 3 doses/day

Pathogen-Based Therapy — Bacteria Adapted from Lancet. 2010;375(9717):846-55.[3] and Clin Microbiol Rev. 2002;15(4):527-44.[4]

▸ Click on the following categories to expand treatment regimens.

Bacteria

  ▸  Bacteroides fragilis

  ▸  Brucella melitensis

  ▸  Enterococcus spp.

  ▸  Escherichia coli

  ▸  Haemophilus influenzae

  ▸  Morganella morganii

  ▸  Neisseria gonorrhoeae

  ▸  Proteus mirabilis

  ▸  Proteus vulgaris, Proteus rettgeri

  ▸  Pseudomonas aeruginosa

  ▸  Serratia marcescens

  ▸  Staphylococcus aureus

  ▸  Staphylococcus epidermidis

  ▸  Streptococcus agalactiae

  ▸  Streptococcus pyogenes

  ▸  Tropheryma whipplei

Mycobacteria

  ▸  Mycobacterium tuberculosis

Spirochetes

  ▸  Borrelia burgdorferi

  ▸  Treponema pallidum

Bacteroides fragilis
Preferred Regimen
Clindamycin 900 mg IV/IM q8h
OR
Metronidazole 500 mg IV q8h
Alternative Regimen
Ampicillin-Sulbactam 3 g IV q6h
OR
Ticarcillin-Clavulanate 3.1 g IV q4–6h
Morganella morganii
Preferred Regimen
Cefotaxime 2 g IV q6h
OR
Imipenem 500 mg IV q6h
OR
Levofloxacin 500 mg IV/PO q24h
Alternative Regimen
Gentamicin 3–5 mg/kg/day IV q6–8h
OR
Ticarcillin-Clavulanate 3.1 g IV q4–6h
Proteus vulgaris, Proteus rettgeri
Preferred Regimen
Cefotaxime 2 g IV q6h
OR
Imipenem 500 mg IV q6h
OR
Levofloxacin 500 mg IV/PO q24h
Alternative Regimen
Gentamicin 3–5 mg/kg/day IV q6–8h
OR
Ticarcillin-Clavulanate 3.1 g IV q4–6h
Serratia marcescens
Preferred Regimen
Cefotaxime 2 g IV q6h
Alternative Regimen
Levofloxacin 500 mg IV/PO q24h
OR
Gentamicin 3–5 mg/kg/day IV q6–8h
OR
Imipenem 500 mg IV q6h
Brucella melitensis
Preferred Regimen
Doxycycline 100 mg PO bid for ≥6 weeks
PLUS
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
PLUS
Gentamicin 5 mg/kg IV qd for 7 days
Adapted from PLoS Med. 2007;4(12):e317.[5] and Lancet Infect Dis. 2007;7(12):775-86.[6] and Cochrane Database Syst Rev. 2012;10:CD007179.[7]
Methicillin-Sensitive S. aureus
Preferred Regimen
Nafcillin 2 g IV q6h
OR
Clindamycin 900 mg IV q8h
Alternative Regimen
Cefazolin 0.25–1 g IV/IM q6–8h
OR
Vancomycin 500 mg IV q6h (or 1 g IV q12h)
Methicillin-Resistant S. aureus (Adult)
Preferred Regimen
Vancomycin 15–20 mg/kg IV q8–12h
OR
Daptomycin 6 mg/kg IV q24h
OR
Linezolid 600 mg PO/IV q12h
Alternative Regimen 1
TMP-SMX 3.5–4.0 mg/kg PO/IV q8–12h (TMP component)
PLUS
Rifampin 300–600 mg PO/IV q12h
Alternative Regimen 2
Clindamycin 600 mg IV/IM q8h
Methicillin-Resistant S. aureus (Pediatric)
Preferred Regimen
Vancomycin 15 mg/kg IV q6h
OR
Clindamycin 10 mg/kg PO/IV q6h (or 13 mg/kg PO/IV q8h)
Alternative Regimen
Daptomycin 6–10 mg/kg IV q24h
OR
Linezolid 10 mg/kg PO/IV q8h (Maximum: 600 mg/dose)
Adapted from Clin Infect Dis. 2011;52(3):e18-55.[8]
Methicillin-Sensitive S. epidermidis
Preferred Regimen
Nafcillin 2 g IV q6h
OR
Clindamycin 900 mg IV/IM q8h
Alternative Regimen
Cefazolin 0.25–1 g IV/IM q6–8h
OR
Vancomycin 500 mg IV q6h (or 1 g IV q12h)
Methicillin-Resistant S. epidermidis
Preferred Regimen
Vancomycin 500 mg IV q6h (or 1 g IV q12h)
OR
Linezolid 600 mg IV q12h
Alternative Regimen 1
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
PLUS
Rifampin 300–600 mg PO/IV q12h
Alternative Regimen 2
Clindamycin 900 mg IV/IM q8h
Streptococcus agalactiae
Preferred Regimen
Penicillin G 2 MU IV/IM q4h
OR
Ampicillin 2 g IV q6h
Alternative Regimen
Clindamycin 600–1200 mg/day IV/IM q6–12h
OR
Cefazolin 0.25–1 g IV/IM q6–8h
Streptococcus pyogenes
Preferred Regimen
Penicillin G 2 MU IV/IM q4h
OR
Ampicillin 2 g IV q6h
Alternative Regimen
Clindamycin 600–1200 mg/day IV/IM q6–12h
OR
Cefazolin 0.25–1 g IV/IM q6–8h
Escherichia coli
Preferred Regimen
Ampicillin-Sulbactam 3 g IV q6h
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)
Pseudomonas aeruginosa
Preferred Regimen
Cefepime 2 g IV q12h
OR
Piperacillin 3–4 g IV q4–6h
OR
Imipenem 500 mg IV q6h
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
Neisseria gonorrhoeae
Preferred Regimen
Ceftriaxone 2 g IV q24h
OR
Cefotaxime 1 g IV q8h
Alternative Regimen
Levofloxacin 500 mg IV/PO q24h
OR
Ampicillin 2 g IV q6h
Haemophilus influenzae
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
Alternative Regimen
Levofloxacin 750 mg IV/PO q24h
OR
Moxifloxacin 400 mg IV/PO q24h
OR
Clarithromycin 500 mg PO q12h
Mycobacterium tuberculosis
Intensive Phase
Isoniazid 5mg/kg PO q24h for 2 months
OR
Isoniazid 10 mg/kg PO 3 times per week × 2 months
PLUS
Rifampicin 10 mg/kg PO q24h for 2 months
OR
Rifampicin 10 mg/kg PO 3 times per week × 2 months
PLUS
Pyrazinamide 25mg/kg PO q24h for 2 months
OR
Pyrazinamide 35 mg/kg PO 3 times per week × 2 months
PLUS
Ethambutol 15mg/kg PO q24h for 2 months
Continuation Phase
Isoniazid 5mg/kg PO for 4-7 months
OR
Isoniazid 10 mg/kg PO 3 times per week × 4-7 months
PLUS
Rifampicin 10 mg/kg PO q24h for 4-7 months
OR
Rifampicin 10 mg/kg PO 3 times per week for 4-7 months
Adapted from Treatment of Tuberculosis: Guidelines.[9]
Borrelia burgdorferi
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
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
Adapted from IDSA Guidelines: The Clinical Assessment, Treatment, and Prevention of Lyme Disease, Human Granulocytic Anaplasmosis, and Babesiosis: [10]
Treponema pallidum
Preferred Regimen
Penicillin G 2.4 MU IM single dose
Alternative Regimen
Doxycycline 100 mg PO q12h x 14 days
OR
Tetracycline 500 mg PO q6h x 14 days
OR
Ceftriaxone 1 g IM/IV q24h x 10 -14 days
Adapted from MMWR Recomm Rep. 2006;55(RR-11):1-94[11]
Tropheryma whipplei
Preferred Regimen
Penicillin G 2 MU IV q4h for 2 weeks
PLUS
Streptomycin 1 g IM/IV q24h for 2 weeks
FOLLOWED BY
Trimethoprim/Sulfamethoxazole 160mg/800mg PO q24h for 1 year
Alternative Regimen
Ceftriaxone 2 g IV q24h
FOLLOWED BY
Trimethoprim/Sulfamethoxazole 160mg/800mg PO q24h for 1 year
Adapted from N Engl J Med 2007; 356:55-66 [12]
Enterococcus spp.
Preferred Regimen
Ampicillin 2 g IV q6h
OR
Vancomycin 1 g IV q12h
Alternative Regimen
Ampicillin-Sulbactam 3 g IV q6h
OR
Linezolid 600 mg PO/IV q12h
Proteus mirabilis
Preferred Regimen
Ampicillin 2 g IV q6h
OR
Levofloxacin 500 mg IV/PO q24h
Alternative Regimen
Cefazolin 0.25–1 g IV/IM q6–8h
OR
TMP-SMX 8–10 mg/kg/day IV/PO q6–12h (TMP component)
OR
Gentamicin 3–5 mg/kg/day IV q6–8h

Pathogen-Based Therapy — Fungi

▸ Click on the following categories to expand treatment regimens.

Fungi

  ▸  Aspergillus spp.

  ▸  Blastomyces dermatitidis

  ▸  Candida spp.

  ▸  Coccidioides immitis

  ▸  Histoplasma

  ▸  Sporothrix

Aspergillus spp.
Preferred Regimen
Voriconazole 6 mg/kg IV q12h on day 1
FOLLOWED BY
Voriconazole 4 mg/kg IV q12h (goal trough: 1.0–5.5 mg/L)
OR
Voriconazole 200 mg PO q12h (for body weight ≥40 kg)
OR
Voriconazole 100 mg PO q12h (for body weight <40 kg)
Alternative Regimen
Liposomal amphotericin B 3-5 mg/kg/day IV
OR
Amphotericin B lipid complex 5 mg/kg/day IV
OR
Caspofungin 70 mg IV on day 1, then 50 mg IV q24h
OR
Micafungin 100 mg IV q12h (or 250 mg IV q24h)
OR
Itraconazole 200 mg PO tid for 3 days, then 200 mg PO bid
Adapted from Clin Infect Dis. 2008; 46:327–60.[13]

Adapted from Clin Infect Dis. 2012;55(8):1080-7.[14]

Adapted from J Antimicrob Chemother. 2009;64(4):840-4.[15]

Blastomyces dermatitidis
Moderately Severe to Severe Disease
Liposomal amphotericin B 3–5 mg/kg/day IV for 1–2 weeks
OR
Amphotericin B 0.7–1 mg/kg/day IV for 1–2 weeks
FOLLOWED BY
Itraconazole 200 mg PO tid for 3 days
FOLLOWED BY
Itraconazole 200 mg PO bid for ≥12 months totally
Mild to Moderate Disease
Itraconazole 200 mg PO tid for 3 days
FOLLOWED BY
Itraconazole 200 mg PO qd–bid for 6–12 months
Adapted from Clin Infect Dis. 2008;46(12):1801-12.[16]
Candida spp.
Preferred Regimen
Fluconazole 400 mg/day (or 6 mg/kg/day) IV/PO for ≥2 weeks
OR
Lipid-based amphotericin B 3–5 mg/kg/day IV for ≥2 weeks
FOLLOWED BY
Fluconazole 400 mg/day IV/PO for ≥6 weeks totally
Alternative Regimen
Anidulafungin 200 mg IV on day 1, then 100 mg/day IV for ≥2 weeks
OR
Caspofungin 70 mg IV on day 1, then 50 mg IV q24h for ≥2 weeks
OR
Micafungin 100 mg IV q24h for ≥2 weeks
OR
Amphotericin B 0.5–1 mg/kg/day IV for ≥2 weeks
FOLLOWED BY
Fluconazole 400 mg/day IV/PO for ≥6 weeks totally
Adapted from Clin Infect Dis. 2009;48(5):503-35.[17]
Coccidioides immitis
Preferred Regimen
Itraconazole 200 mg q12h (max: 800 mg/day) for ≥6 weeks
OR
Fluconazole 400-600 mg/day (max: 2000 mg/day) for ≥6 weeks
OR
Ketoconazole 400 mg/day for ≥6 weeks
Alternative Regimen
Amphotericin B 0.5–1.5 mg/kg/day
Adapted from Clin Infect Dis. 2005;41(9):1217-23.[18] and N Engl J Med 1995; 332:1077-1082 [19]

Histoplasma capsulatum
Preferred Regimen
Moderate Severe to Severe Disease
Liposomal Amphotericin B 3 mg/kg/day IV × 1-2 weeks
OR
Amphotericin B deoxycholate 0.7-1 mg/kg/day IV × 1-2 weeks
OR
Amphotericin B lipid complex 5 mg/kg/day IV × 1-2 weeks
FOLLOWED BY
Itraconazole 200 mg PO q12h x ≥12 months
Mild to Moderate Disease
Itraconazole 200 mg PO q12h x ≥12 months
Adapted from Clin Infect Dis. 2007;45(7):807-25.[20]
Sporothrix
Preferred Regimen
Itraconazole 200 mg q12h x 12 months
Alternative Regimen
Liposomal Amphotericin B 3-5 mg/kg/day IV × for 1-2 weeks
OR
Amphotericin B deoxycholate 0.7-1 mg/kg/day IV × 1-2 weeks
FOLLOWED BY
Itraconazole 200 mg PO q12h x 12 months
Adapted from Clin Infect Dis. 2007; 45:1255–65[21]

Pathogen-Based Therapy — Virus

The treatment for viral arthritis is symptomatic, with the use of analgesics and NSAID. No antimicrobial therapy is recommended for treating arthritis caused by a virus.[22][23]
Vaccination and safe sex are the most important measures to avoid viral infections in the joint.

Pathogen-Based Therapy in Patients with Prosthetic Joint Adapted from Diagnosis and Management of Prosthetic Joint Infection CID 2013:56[24]

▸ Click on the following categories to expand treatment regimens.

Bacteria

  ▸  Staphylococci, oxacillin-susceptible

  ▸  Staphylococci, oxacillin-resistant

  ▸  Enterococcus spp, penicillin-susceptible

  ▸  Enterococcus spp, penicillin-resistant

  ▸  Pseudomonas aeruginosa

  ▸  Enterobacter spp

  ▸  Enterobacteriaceae

  ▸  β-hemolytic streptococci

  ▸  Propionibacterium acnes

Staphylococci, oxacillin-susceptible
Preferred Regimen
Nafcillin 1.5-2 g IV q4-6h
OR
Cefazolin 1–2 g IV q8 h
OR
Ceftriaxone 1–2 g IV q24h
Alternative Regimen
Vancomycin IV 15 mg/kg q12h
OR
Daptomycin 6 mg/kg IV q24h
OR
Linezolid 600 mg PO/IV q12h
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
Pseudomonas aeruginosa
Preferred Regimen
Cefepime 2 g IV q12 h
OR
Meropenem 1 g IV q8 h
Alternative Regimen
Ciprofloxacin 750 mg PO q12h or 400 mg IV q12h
OR
Ceftazidime 2 g IV q8h
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
Enterobacteriaceae
Preferred Regimen
IV β-lactam based on in vitro susceptibilities
OR
Ciprofloxacin 750 mg PO q12h
β-hemolytic streptococci
Preferred Regimen
Penicillin G 20-40 MU IV q24h continuously or divided in 6 doses
OR
Ceftriaxone 2 g IV q24h
Alternative Regimen
Vancomycin 15mg/kg IV q12h
Propionibacterium acnes
Preferred Regimen
Penicillin G 20-40 MU IV q24h continuously or divided in 6 doses
OR
Ceftriaxone 2 g IV q24h
Alternative Regimen
Clindamycin 600–900 mg IV q8h
OR
Clindamycin300–450 mg PO q6h
OR
Vancomycin 15mg/kg IV q12h


References

  1. Mathews, CJ.; Weston, VC.; Jones, A.; Field, M.; Coakley, G. (2010). "Bacterial septic arthritis in adults". Lancet. 375 (9717): 846–55. doi:10.1016/S0140-6736(09)61595-6. PMID 20206778. Unknown parameter |month= ignored (help)
  2. Mandell, Gerald L.; Bennett, John E. (John Eugene); Dolin, Raphael. (2010). Mandell, Douglas, and Bennett's principles and practice of infectious disease. Philadelphia, PA: Churchill Livingstone/Elsevier.
  3. Mathews CJ, Weston VC, Jones A, Field M, Coakley G (2010). "Bacterial septic arthritis in adults". Lancet. 375 (9717): 846–55. doi:10.1016/S0140-6736(09)61595-6. PMID 20206778.
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