Septic arthritis medical therapy: Difference between revisions

	Septic arthritis Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Septic Arthritis from other Diseases
Epidemiology and Demographics
Risk Factors
Natural History, Complications and Prognosis
Diagnosis
History and Symptoms
Physical Examination
Laboratory Findings
X Ray
CT
MRI
Other Diagnostic Studies
Treatment
Medical Therapy
Surgical Therapy
Primary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Septic arthritis medical therapy On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Septic arthritis medical therapy All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Septic arthritis medical therapy
CDC on Septic arthritis medical therapy
Septic arthritis medical therapy in the news
Blogs on Septic arthritis medical therapy
Directions to Hospitals Treating Septic arthritis
Risk calculators and risk factors for Septic arthritis medical therapy

VisualWikitext

Revision as of 12:38, 29 April 2015

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-intraarticular 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

↑ 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)
↑ 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.
↑ 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.
↑ Shirtliff ME, Mader JT (2002). "Acute septic arthritis". Clin Microbiol Rev. 15 (4): 527–44. PMC 126863. PMID 12364368.CS1 maint: PMC format (link)
↑ Ariza, Javier; Bosilkovski, Mile; Cascio, Antonio; Colmenero, Juan D.; Corbel, Michael J.; Falagas, Matthew E.; Memish, Ziad A.; Roushan, Mohammad Reza Hasanjani; Rubinstein, Ethan; Sipsas, Nikolaos V.; Solera, Javier; Young, Edward J.; Pappas, Georgios (2007). "Perspectives for the Treatment of Brucellosis in the 21st Century: The Ioannina Recommendations". PLoS Medicine. 4 (12): e317. doi:10.1371/journal.pmed.0040317. ISSN 1549-1277.
↑ Franco MP, Mulder M, Gilman RH, Smits HL (2007). "Human brucellosis". Lancet Infect Dis. 7 (12): 775–86. doi:10.1016/S1473-3099(07)70286-4. PMID 18045560.
↑ Yousefi-Nooraie R, Mortaz-Hejri S, Mehrani M, Sadeghipour P (2012). "Antibiotics for treating human brucellosis". Cochrane Database Syst Rev. 10: CD007179. doi:10.1002/14651858.CD007179.pub2. PMID 23076931.
↑ Liu, C.; Bayer, A.; Cosgrove, S. E.; Daum, R. S.; Fridkin, S. K.; Gorwitz, R. J.; Kaplan, S. L.; Karchmer, A. W.; Levine, D. P.; Murray, B. E.; Rybak, M. J.; Talan, D. A.; Chambers, H. F. (2011). "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. 52 (3): e18–e55. doi:10.1093/cid/ciq146. ISSN 1058-4838.
↑ Treatment of tuberculosis : guidelin. Geneva: World Health Organization. 2010. ISBN 978-92-4-154783-3.
↑ . doi:10.1086/522848. Missing or empty |title= (help)
↑ "http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5511a1.htm". Retrieved 19 May 2014. External link in |title= (help)
↑ Fenollar, Florence; Puéchal, Xavier; Raoult, Didier (2007). "Whipple's Disease". New England Journal of Medicine. 356 (1): 55–66. doi:10.1056/NEJMra062477. ISSN 0028-4793.
↑ Walsh, Thomas J.; Anaissie, Elias J.; Denning, David W.; Herbrecht, Raoul; Kontoyiannis, Dimitrios P.; Marr, Kieren A.; Morrison, Vicki A.; Segal, Brahm H; Steinbach, William J.; Stevens, David A.; Burik, Jo‐Anne van; Wingard, John R.; Patterson, Thomas F. (2008). "Treatment of Aspergillosis: Clinical Practice Guidelines of the Infectious Diseases Society of America". Clinical Infectious Diseases. 46 (3): 327–360. doi:10.1086/525258. ISSN 1058-4838.
↑ Park WB, Kim NH, Kim KH, Lee SH, Nam WS, Yoon SH; et al. (2012). "The effect of therapeutic drug monitoring on safety and efficacy of voriconazole in invasive fungal infections: a randomized controlled trial". Clin Infect Dis. 55 (8): 1080–7. doi:10.1093/cid/cis599. PMID 22761409.
↑ Ikawa K, Nomura K, Morikawa N, Ikeda K, Taniwaki M (2009). "Assessment of micafungin regimens by pharmacokinetic-pharmacodynamic analysis: a dosing strategy for Aspergillus infections". J Antimicrob Chemother. 64 (4): 840–4. doi:10.1093/jac/dkp298. PMID 19700475.
↑ Chapman, SW.; Dismukes, WE.; Proia, LA.; Bradsher, RW.; Pappas, PG.; Threlkeld, MG.; Kauffman, CA. (2008). "Clinical practice guidelines for the management of blastomycosis: 2008 update by the Infectious Diseases Society of America". Clin Infect Dis. 46 (12): 1801–12. doi:10.1086/588300. PMID 18462107. Unknown parameter |month= ignored (help)
↑ Pappas, PG.; Kauffman, CA.; Andes, D.; Benjamin, DK.; Calandra, TF.; Edwards, JE.; Filler, SG.; Fisher, JF.; Kullberg, BJ. (2009). "Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America". Clin Infect Dis. 48 (5): 503–35. doi:10.1086/596757. PMID 19191635. Unknown parameter |month= ignored (help)
↑ Galgiani, JN.; Ampel, NM.; Blair, JE.; Catanzaro, A.; Johnson, RH.; Stevens, DA.; Williams, PL. (2005). "Coccidioidomycosis". Clin Infect Dis. 41 (9): 1217–23. doi:10.1086/496991. PMID 16206093. Unknown parameter |month= ignored (help)
↑ Stevens, David A. (1995). "Coccidioidomycosis". New England Journal of Medicine. 332 (16): 1077–1082. doi:10.1056/NEJM199504203321607. ISSN 0028-4793.
↑ Wheat, LJ.; Freifeld, AG.; Kleiman, MB.; Baddley, JW.; McKinsey, DS.; Loyd, JE.; Kauffman, CA. (2007). "Clinical practice guidelines for the management of patients with histoplasmosis: 2007 update by the Infectious Diseases Society of America". Clin Infect Dis. 45 (7): 807–25. doi:10.1086/521259. PMID 17806045. Unknown parameter |month= ignored (help)
↑ Kauffman, C. A.; Bustamante, B.; Chapman, S. W.; Pappas, P. G. (2007). "Clinical Practice Guidelines for the Management of Sporotrichosis: 2007 Update by the Infectious Diseases Society of America". Clinical Infectious Diseases. 45 (10): 1255–1265. doi:10.1086/522765. ISSN 1058-4838.
↑ Berner, IC.; Dudler, J. (2006). "[Viral arthritis]". Rev Med Suisse. 2 (57): 732–4, 737. PMID 16604875. Unknown parameter |month= ignored (help)
↑ Märker-Hermann, E.; Schütz, N.; Bauer, H. (2010). "[Viral arthritides]". Z Rheumatol. 69 (10): 871–8. doi:10.1007/s00393-010-0701-6. PMID 21128048. Unknown parameter |month= ignored (help)
↑ 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.

Template:WikiDoc Sources

[Mathews-2010-1] 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.

[pmid20206778-3] 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.

[pmid12364368-4] Shirtliff ME, Mader JT (2002). "Acute septic arthritis". Clin Microbiol Rev. 15 (4): 527–44. PMC 126863. PMID 12364368.CS1 maint: PMC format (link)

[ArizaBosilkovski2007-5] Ariza, Javier; Bosilkovski, Mile; Cascio, Antonio; Colmenero, Juan D.; Corbel, Michael J.; Falagas, Matthew E.; Memish, Ziad A.; Roushan, Mohammad Reza Hasanjani; Rubinstein, Ethan; Sipsas, Nikolaos V.; Solera, Javier; Young, Edward J.; Pappas, Georgios (2007). "Perspectives for the Treatment of Brucellosis in the 21st Century: The Ioannina Recommendations". PLoS Medicine. 4 (12): e317. doi:10.1371/journal.pmed.0040317. ISSN 1549-1277.

[pmid18045560-6] Franco MP, Mulder M, Gilman RH, Smits HL (2007). "Human brucellosis". Lancet Infect Dis. 7 (12): 775–86. doi:10.1016/S1473-3099(07)70286-4. PMID 18045560.

[pmid23076931-7] Yousefi-Nooraie R, Mortaz-Hejri S, Mehrani M, Sadeghipour P (2012). "Antibiotics for treating human brucellosis". Cochrane Database Syst Rev. 10: CD007179. doi:10.1002/14651858.CD007179.pub2. PMID 23076931.

[LiuBayer2011-8] Liu, C.; Bayer, A.; Cosgrove, S. E.; Daum, R. S.; Fridkin, S. K.; Gorwitz, R. J.; Kaplan, S. L.; Karchmer, A. W.; Levine, D. P.; Murray, B. E.; Rybak, M. J.; Talan, D. A.; Chambers, H. F. (2011). "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. 52 (3): e18–e55. doi:10.1093/cid/ciq146. ISSN 1058-4838.

[9] Treatment of tuberculosis : guidelin. Geneva: World Health Organization. 2010. ISBN 978-92-4-154783-3.

[10] . doi:10.1086/522848. Missing or empty |title= (help)

[www.cdc.gov-11] "http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5511a1.htm". Retrieved 19 May 2014. External link in |title= (help)

[FenollarPuéchal2007-12] Fenollar, Florence; Puéchal, Xavier; Raoult, Didier (2007). "Whipple's Disease". New England Journal of Medicine. 356 (1): 55–66. doi:10.1056/NEJMra062477. ISSN 0028-4793.

[WalshAnaissie2008-13] Walsh, Thomas J.; Anaissie, Elias J.; Denning, David W.; Herbrecht, Raoul; Kontoyiannis, Dimitrios P.; Marr, Kieren A.; Morrison, Vicki A.; Segal, Brahm H; Steinbach, William J.; Stevens, David A.; Burik, Jo‐Anne van; Wingard, John R.; Patterson, Thomas F. (2008). "Treatment of Aspergillosis: Clinical Practice Guidelines of the Infectious Diseases Society of America". Clinical Infectious Diseases. 46 (3): 327–360. doi:10.1086/525258. ISSN 1058-4838.

[pmid22761409-14] Park WB, Kim NH, Kim KH, Lee SH, Nam WS, Yoon SH; et al. (2012). "The effect of therapeutic drug monitoring on safety and efficacy of voriconazole in invasive fungal infections: a randomized controlled trial". Clin Infect Dis. 55 (8): 1080–7. doi:10.1093/cid/cis599. PMID 22761409.

[pmid19700475-15] Ikawa K, Nomura K, Morikawa N, Ikeda K, Taniwaki M (2009). "Assessment of micafungin regimens by pharmacokinetic-pharmacodynamic analysis: a dosing strategy for Aspergillus infections". J Antimicrob Chemother. 64 (4): 840–4. doi:10.1093/jac/dkp298. PMID 19700475.

[Chapman-2008-16] Chapman, SW.; Dismukes, WE.; Proia, LA.; Bradsher, RW.; Pappas, PG.; Threlkeld, MG.; Kauffman, CA. (2008). "Clinical practice guidelines for the management of blastomycosis: 2008 update by the Infectious Diseases Society of America". Clin Infect Dis. 46 (12): 1801–12. doi:10.1086/588300. PMID 18462107. Unknown parameter |month= ignored (help)

[Pappas-2009-17] Pappas, PG.; Kauffman, CA.; Andes, D.; Benjamin, DK.; Calandra, TF.; Edwards, JE.; Filler, SG.; Fisher, JF.; Kullberg, BJ. (2009). "Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America". Clin Infect Dis. 48 (5): 503–35. doi:10.1086/596757. PMID 19191635. Unknown parameter |month= ignored (help)

[Galgiani-2005-18] Galgiani, JN.; Ampel, NM.; Blair, JE.; Catanzaro, A.; Johnson, RH.; Stevens, DA.; Williams, PL. (2005). "Coccidioidomycosis". Clin Infect Dis. 41 (9): 1217–23. doi:10.1086/496991. PMID 16206093. Unknown parameter |month= ignored (help)

[Stevens1995-19] Stevens, David A. (1995). "Coccidioidomycosis". New England Journal of Medicine. 332 (16): 1077–1082. doi:10.1056/NEJM199504203321607. ISSN 0028-4793.

[Wheat-2007-20] Wheat, LJ.; Freifeld, AG.; Kleiman, MB.; Baddley, JW.; McKinsey, DS.; Loyd, JE.; Kauffman, CA. (2007). "Clinical practice guidelines for the management of patients with histoplasmosis: 2007 update by the Infectious Diseases Society of America". Clin Infect Dis. 45 (7): 807–25. doi:10.1086/521259. PMID 17806045. Unknown parameter |month= ignored (help)

[KauffmanBustamante2007-21] Kauffman, C. A.; Bustamante, B.; Chapman, S. W.; Pappas, P. G. (2007). "Clinical Practice Guidelines for the Management of Sporotrichosis: 2007 Update by the Infectious Diseases Society of America". Clinical Infectious Diseases. 45 (10): 1255–1265. doi:10.1086/522765. ISSN 1058-4838.

[Berner-2006-22] Berner, IC.; Dudler, J. (2006). "[Viral arthritis]". Rev Med Suisse. 2 (57): 732–4, 737. PMID 16604875. Unknown parameter |month= ignored (help)

[Märker-Hermann-2010-23] Märker-Hermann, E.; Schütz, N.; Bauer, H. (2010). "[Viral arthritides]". Z Rheumatol. 69 (10): 871–8. doi:10.1007/s00393-010-0701-6. PMID 21128048. Unknown parameter |month= ignored (help)

[OsmonBerbari2012-24] 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.

[1]

[2]

[3]

[4]

[5]

[6]

[7]

[8]

[9]

[10]

[11]

[12]

[13]

[14]

[15]

[16]

[17]

[18]

[19]

[20]

[21]

[22]

[23]

[24]

@@ Line 16: / Line 16: @@
 {| style="border: 2px solid #696969;"
 |+ <SMALL>''Recommended Duration of Antimicrobial Therapy Based on Isolated Pathogen.''</SMALL>
-| style="background: #545454; border: 0px solid #696969; padding: 0 5px; width: 300px; color: #F8F8FF;"| '''''Microorganism''''' || style="background: #545454; border: 0px solid #696969; padding: 0 5px; width: 300px; color: #F8F8FF;" | '''Duration of Therapy'''
+| style="background: #545454; border: 0px solid #696969; padding: 0 5px; width: 400px; color: #F8F8FF;"| '''''Microorganism''''' || style="background: #545454; border: 0px solid #696969; padding: 0 5px; width: 400px; color: #F8F8FF;" | '''Duration of Therapy'''
 |-
-| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left |&nbsp;▸&nbsp;'''''[[Staphylococcus aureus]]''''' || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ''''' 3-4 weeks'''''
+| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left |&nbsp;▸&nbsp;'''''[[Staphylococcus aureus]]''''' || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ''''' 3–4 weeks'''''
 |-
-| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left |&nbsp;▸&nbsp;'''''[[Streptococcus|Streptococcus groups A, B, C, G]]''''' || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ''''' 3-4 weeks'''''
+| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left |&nbsp;▸&nbsp;'''''[[Streptococcus|Streptococcus groups A, B, C, G]]''''' || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ''''' 3–4 weeks'''''
 |-
 | style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left |&nbsp;▸&nbsp;'''''[[Gram-negative bacilli]]''''' || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ''''' 4 weeks'''''
@@ Line 36: / Line 36: @@
 {| style="border: 2px solid #696969;"
-| style="background: #545454; border: 0px solid #696969; padding: 0 5px; width: 300px; color: #F8F8FF;"| '''''Special cases''''' || style="background: #545454; border: 0px solid #696969; padding: 0 5px; width: 300px; color: #F8F8FF;" | '''Duration of Therapy'''
+| style="background: #545454; border: 0px solid #696969; padding: 0 5px; width: 400px; color: #F8F8FF;"| '''''Special cases''''' || style="background: #545454; border: 0px solid #696969; padding: 0 5px; width: 400px; color: #F8F8FF;" | '''Duration of Therapy'''
 |-
 | style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left |&nbsp;▸&nbsp;'''''Prosthetic joint infection''''' || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ''''' 6 weeks'''''
 |-
-| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left |&nbsp;▸&nbsp;'''''Post intra-articular injection or post-arthroscopy infection''''' || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left |  '''''14 days'''''
+| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left |&nbsp;▸&nbsp;'''''Post-intraarticular injection or post-arthroscopy infection''''' || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left |  '''''14 days'''''
 |-
 |}

Septic arthritis medical therapy: Difference between revisions

Revision as of 12:38, 29 April 2015

Overview

Medical Therapy

Duration of Antimicrobial Therapy

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

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

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

Pathogen-Based Therapy — Fungi

Pathogen-Based Therapy — Virus

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

References

Navigation menu

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

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

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

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