Sandbox ID Musculoskeletal

Septic arthritis, Brucella melitensis

• Preferred Regimen: Doxycycline 100 mg PO bid for ≥ 6 weeks AND 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 AND Gentamicin 5 mg/kg IV qd for 7 days

Septic arthritis, candidal

• Preferred regime: Fluconazole 400 mg (6 mg/kg) daily for at least 6 weeks OR lipid formulation of amphotericin B 3–5 mg/kg daily for several weeks, then Fluconazole to completion
• Alternative regime: Anidulafungin 200-mg loading dose, then 100 mg/day OR Caspofungin 70-mg loading dose, then 50 mg/day OR Micafungin 100 mg/day OR Amphotericin B deoxycholate 0.5–1 mg/kg daily for several weeks then Fluconazole to completion
• NOTE: Duration of therapy usually is for at least 6 weeks, but few data are available; Surgical debridement is recommended for all cases; For infected prosthetic joints, removal is recommended for most cases.

Septic arthritis, Gram-negative bacilli

• Preferred regime: Ceftazidime 2 g IV q8h OR Cefepime 2 g IV q8–12h OR Piperacillin-Tazobactam 4.5 g IV q6h

• Alternative regime: Aztreonam 2 g IV q8h OR Imipenem 500 mg IV q6h OR Meropenem 1 g IV q8h {or}} Doripenem 500 mg IV q8h OR Carbapenems

Septic arthritis, staphylococcal

Staphylococcus aureus (methicillin-resistant)

• Preferred regime: Vancomycin 15–20 mg/kg IV q8–12h

• Alternative regime (1): Daptomycin 6 mg/kg IV q24h in adults
• Alternative regime (2): Linezolid 600 mg PO/IV q12h

• Alternative regime (3): Clindamycin 600 mg PO/IV q8h
• Alternative regime (4): TMP-SMX 3.5–4.0 mg/kg PO/IV q8–12h

• Pediatric regime: Vancomycin 15 mg/kg IV q6h OR Daptomycin 6–10 mg/kg IV q24h OR Linezolid 10 mg/kg PO/IV q8h OR Clindamycin 10–13 mg/kg/dose PO/IV q6–8h

Staphylococcus aureus (methicillin-susceptible)

• Preferred regime: Nafcillin 2 g IV q6h OR Clindamycin 900 mg IV q8h
• Alternative regime: Cefazolin 0.25–1 g IV/IM q6–8h OR Vancomycin 500 mg IV q6h or 1 g IV q12h

Staphylococcus epidermidis (methicillin-resistant)

• Preferred regime: Vancomycin 500 mg IV q6h or 1 g IV q12h OR Linezolid 600 mg IV q12h
• Alternative regime: 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 AND Rifampin 300–600 mg PO/IV q12h

Staphylococcus epidermidis (methicillin-susceptible)

• Preferred regime: Nafcillin 2 g IV q6h OR Clindamycin 900 mg IV q8h
• Alternative regime: Cefazolin 0.25–1 g IV/IM q6–8h OR Vancomycin 500 mg IV q6h or 1 g IV q12h

Septic arthritis, streptococcal

Streptococcus agalactiae

• Preferred regime: Penicillin G 2 MU IV/IM q4h OR Ampicillin 2 g IV q6h

• Alternative regime: Clindamycin 600–1200 mg/day IV/IM q6–12h OR Cefazolin 0.25–1 g IV/IM q6–8h

Streptococcus pyogenes

• Preferred regime: Penicillin G 2 MU IV/IM q4h OR Ampicillin 2 g IV q6h

• Alternative regime: Clindamycin 600–1200 mg/day IV/IM q6–12h OR Cefazolin 0.25–1 g IV/IM q6–8h