Infectious Tenosynovitis Organism-Specific Therapy 

Updated: Jan 28, 2016
  • Author: Jefferson R Roberts, MD; Chief Editor: Thomas E Herchline, MD  more...
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Specific Organisms and Therapeutic Regimens

Organism-specific therapeutic regimens for infectious tenosynovitis are provided below, including those for the following pathogens:

  • Methicillin-susceptible Staphylococcus aureus
  • Methicillin-resistant S aureus
  • Streptococcus species
  • Pseudomonas aeruginosa
  • Neisseria gonorrhoeae
  • Pasteurella multocida
  • Mycobacterium marinum
  • Sporothrix schenckii
  • Coccidioides species

Staphylococcus aureus (methicillin susceptible)  [1, 2, 3, 4]

  • Penicillin G 4 million units IV q4h or
  • Nafcillin 2 g IV q4h or
  • Oxacillin 2 g IV q4h or
  • Cefazolin 2 g IV q8h or
  • Cephalexin 250-1000 mg PO q6h
  • Duration of therapy: 7-14 days; should be individualized on the basis of patient’s clinical response

Staphylococcus aureus (methicillin resistant)  [5, 1, 6, 7, 8]

  • Doxycycline 100 mg PO q12h or
  • Trimethoprim-sulfamethoxazole (160 mg/800 mg) 1 DS tablet PO BID or
  • Clindamycin 300-600 mg PO/IV TID or
  • Vancomycin 15-20 mg/kg q8-12h or
  • Linezolid 600 mg PO/IV q12h or
  • Daptomycin 4-6 mg/kg IV q24h
  • Duration of therapy: 7-14 days; should be individualized on the basis of patient’s clinical response

Streptococcus species  [9]

  • Penicillin G 4 million units IV q4h or
  • Clindamycin 300-600 mg PO/IV TID or
  • Ceftriaxone 1 g IV q24h or
  • Amoxicillin-clavulanate (875 mg/125 mg) PO BID or
  • Ampicillin-sulbactam 1-2 g IV q6h
  • Duration of therapy: 7-14 days; should be individualized on the basis of patient’s clinical response

Pseudomonas aeruginosa [10, 11]

  • Ceftazidime 2 g IV q8h or
  • Cefepime 1-2 g Q8 hr q8h or
  • Ciprofloxacin 400 mg IV q8h or
  • Aztreonam 2 g IV q8h or
  • Meropenem 1 g IV q8h or
  • Imipenem 500 mg q6h
  • Duration of therapy: 7-14 days; should be individualized on the basis of patient’s clinical response

Neisseria gonorrhoeae [12]

  • Ceftriaxone 1 g q24h or
  • Cefotaxime 1 g IV q8h or
  • Ceftizoxime 1 g IV q8h

All of the preceding regimens should be continued for 24-48 hours after improvement begins, at which time therapy can be switched to cefixime 400 mg PO BID to complete at least 1 week of antimicrobial therapy

Pasteurella multocida [13]

  • Amoxicillin-clavulanate (875 mg/125 mg) PO BID or
  • Ampicillin-sulbactam 1-2 g IV q6h or
  • Doxycycline 100 mg PO BID
  • Duration of therapy: 7-10 days

Mycobacterium marinum [14, 15]

  • Clarithromycin 500 mg PO BID plus  rifampin 600 mg PO daily or
  • Clarithromycin 500 mg PO BID plus  ethambutol 15 mg/kg PO daily or
  • Minocycline 100 mg PO BID or
  • Doxycycline 100 mg PO BID or
  • Trimethoprim-sulfamethoxazole (160 mg/800 mg) 1 DS tablet PO BID
  • Duration of therapy: 4-6 wk after symptoms resolve, usually minimum 3 month total

For treatment of Mycobacterium tuberculosis infection, please refer to Tuberculosis Organism-Specific Therapy.

Sporothrix schenckii [16]

  • Itraconazole 200 mg PO BID or
  • Lipid amphotericin B 3-5 mg/kg IV daily until improving, then continue with itraconazole 200 mg PO BID
  • Duration of therapy: At least 12 months

Coccidioides  species  [17, 18, 19]

  • Itraconazole 200 mg PO BID, preferred [17] or
  • Fluconazole 400 mg PO daily or
  • Lipid amphotericin B 3-5 mg/kg IV daily until improving, then continue with itraconazole 200 mg PO BID
  • Duration of therapy: 8 to 12 months or more