Adult
Acute osteoarticular infection, including septic arthritis and acute osteomyelitis
Warning
Consider and treat for sepsis as appropriate.
- Septic arthritis
- Suspected septic arthritis should always be discussed with the orthopaedic doctor on call as urgent joint washout or aspiration is usually indicated.
- Discuss cases with Micro/ID.
- Acute osteomyelitis
- The following empirical treatment is for acute osteomyelitis.
- For chronic osteomyelitis - discuss with Micro/ID.
- Recommended antibiotic therapy listed below is empiric. Treatment should always be tailored to the results from joint aspiration and culture (and/or blood culture).
- Rare pathogens should be considered: discuss with Micro/ID
- Neisseria meningitidis - polyarthropathy
- Neisseria gonorrhoeae – polyarthropathy with enthesitis
- Salmonella spp (especially in sickle cell anaemia)
- Pasteurella multocida – associated with dog and cat bites
- Mycobacterium tuberculosis – usually chronic
- Typical durations
- Micro/ID will advise but typically:
- Septic arthritis 2 weeks
- Acute osteomyelitis 4-6 weeks
- Micro/ID will advise but typically:
Preferred
flucloxacillin 2g iv qds (or 1g po qds)
Oral switch may be considered when patient is improving, clinically settled and is eating and drinking normally.
Alternative
For penicillin allergy (non-severe)
cefazolin* 2g iv tds
OR
cefalexin 1g po tds (increased to 1.5g po every 6-8 hours in severe infection).
Oral switch may be considered when patient is improving, clinically settled and is eating and drinking normally
*Caution: Prothrombin time, INR and APTT may increase on cefazolin treatment courses, please monitor. For more information see Cefazolin associated coagulation disorders
For penicillin allergy (severe) or MRSA positive patients
co-trimoxazole 960mg po bd (or iv if NBM)