Septic Arthritis / Osteomyelitis (Native joint, not diabetic ulcer associated)

Antimicrobial prescribing: NHS Borders
NHS Borders

Duration

Septic arthritis: 4 to 6 weeks

Osteomyelitis:  up to 6 months

First Line

Therapy

First 2 weeks - Flucloxacillin IV 1g to 2g 6 hourly

Then consider oral therapy

If infection not confirmed discuss with microbiology

If risk factors for gram negative infection (for example UTI, prostate symptoms, recent intra-abdominal surgery), add Gentamicin as extended interval dosing as per guideline. Use gentamicin calculator.

Notes:

Penicillin Allergy

Therapy

First 2 weeks - Vancomycin IV dosing as per guideline. Use vancomycin calculator.

Then consider oral therapy

If infection not confirmed discuss with microbiology

If risk factors for gram negative infection (for example UTI, prostate symptoms, recent intra-abdominal surgery), add Gentamicin as extended interval dosing as per guideline. Use gentamicin calculator.  

Notes:

Notes

Blood cultures, joint aspirates and other appropriate samples from potential source of infection MUST be taken prior to therapy.

Discuss with Consultant Microbiologist if risk of Methicillin resistant Staphylococcus aureus or Staphylococcus epidermidis or if gonococcal septic arthritis is suspected.

All therapy should be modified with culture results.