Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Pediatric Septic Arthritis Treatment & Management

  • Author: Richard J Scarfone, MD; Chief Editor: Russell W Steele, MD  more...
 
Updated: Jun 09, 2016
 

Approach Considerations

Hospitalize all children presumed to have septic arthritis (SA) for empiric intravenous antibiotic therapy. After 2-3 days of immobilization, encourage early passive range of motion.

The optimal duration of antibiotic therapy is not defined, and recommendations vary from 1-6 weeks. Thus, institutional practices will prevail. In general, 3-4 weeks of antibiotic therapy is used to treat S aureus,H influenzae type B, or S pneumoniae infections, while gonococcal infections are treated for 7-10 days.

Consultations

Consultation may be indicated with an orthopedic surgeon. Septic arthritis of the hip requires emergent irrigation and drainage to minimize risk of aseptic necrosis of the femoral head. Consultation with an infectious diseases specialist is particularly indicated if the diagnosis is uncertain or if the microbiology is unusual.

Next

Splinting and Antibiotics

Splint the affected joint in a functional position for the first few days after a diagnosis of septic arthritis (SA). Encourage early passive range of motion to stretch tendons and prevent contractures.

Once an organism is identified, an appropriate antibiotic is selected, and the child is demonstrating a good clinical response, continue outpatient therapy with either high-dose oral antibiotics or parenteral antibiotics. Antibiotics readily enter the joint fluid in high concentrations after oral administration. Frequent revisits to the physician to ensure compliance and good clinical response are essential.

 

Previous
Next

Aspiration, Arthrotomy, and Drainage

No studies have compared outcomes for children with SA undergoing arthrotomy versus aspiration alone. Traditionally, for uncomplicated septic arthritis involving joints other than the hip or shoulder, serial needle aspirations are performed. These may be discontinued once fluid no longer reaccumulates. Failure to reach this goal is an indication for arthrotomy and open drainage.

Urgent arthrotomy and open drainage is usually performed in septic arthritis of the hip or shoulder, septic arthritis of other joints if no improvement occurs within 3 days of starting antimicrobial therapy, or if a large amount of pus or debris is aspirated during diagnostic arthrocentesis. However, in one recent study of 62 children with septic arthritis of the hip, 50 were treated successfully with aspiration and antibiotics alone.[13]

Previous
 
 
Contributor Information and Disclosures
Author

Richard J Scarfone, MD Associate Professor, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania; Attending Physician, Division of Emergency Medicine and Medical Director of Emergency Preparedness, The Children's Hospital of Philadelphia

Richard J Scarfone, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Joseph Domachowske, MD Professor of Pediatrics, Microbiology and Immunology, Department of Pediatrics, Division of Infectious Diseases, State University of New York Upstate Medical University

Joseph Domachowske, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa

Disclosure: Received research grant from: Pfizer;GlaxoSmithKline;AstraZeneca;Merck;American Academy of Pediatrics<br/>Received income in an amount equal to or greater than $250 from: Sanofi Pasteur;Astra Zeneca;Novartis<br/>Consulting fees for: Sanofi Pasteur; Novartis; Merck; Astra Zeneca.

Chief Editor

Russell W Steele, MD Clinical Professor, Tulane University School of Medicine; Staff Physician, Ochsner Clinic Foundation

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, Southern Medical Association

Disclosure: Nothing to disclose.

Additional Contributors

Itzhak Brook, MD, MSc Professor, Department of Pediatrics, Georgetown University School of Medicine

Itzhak Brook, MD, MSc is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians-American Society of Internal Medicine, American Medical Association, American Society for Microbiology, Association of Military Surgeons of the US, Infectious Diseases Society of America, International Immunocompromised Host Society, International Society for Infectious Diseases, Medical Society of the District of Columbia, New York Academy of Sciences, Pediatric Infectious Diseases Society, Society for Experimental Biology and Medicine, Society for Pediatric Research, Southern Medical Association, Society for Ear, Nose and Throat Advances in Children, American Federation for Clinical Research, Surgical Infection Society, Armed Forces Infectious Diseases Society

Disclosure: Nothing to disclose.

References
  1. Welkon CJ, Long SS, Fisher MC, Alburger PD. Pyogenic arthritis in infants and children: a review of 95 cases. Pediatr Infect Dis. 1986 Nov-Dec. 5(6):669-76. [Medline].

  2. Thompson A, Mannix R, Bachur R. Acute pediatric monoarticular arthritis: distinguishing lyme arthritis from other etiologies. Pediatrics. 2009 Mar. 123(3):959-65. [Medline].

  3. Kocher MS, Zurakowski D, Kasser JR. Differentiating between septic arthritis and transient synovitis of the hip in children: an evidence-based clinical prediction algorithm. J Bone Joint Surg Am. 1999 Dec. 81(12):1662-70. [Medline].

  4. Caird MS, Flynn JM, Leung YL, et al. Factors distinguishing septic arthritis from transient synovitis of the hip in children. A prospective study. J Bone Joint Surg Am. 2006 Jun. 88(6):1251-7. [Medline].

  5. Kaplan SL. Challenges in the evaluation and management of bone and joint infections and the role of new antibiotics for gram positive infections. Adv Exp Med Biol. 2009. 634:111-20. [Medline].

  6. Taekema HC, Landham PR, Maconochie I. Towards evidence based medicine for paediatricians. Distinguishing between transient synovitis and septic arthritis in the limping child: how useful are clinical prediction tools?. Arch Dis Child. 2009 Feb. 94(2):167-8. [Medline].

  7. [Guideline] Fordham L, Gunderman R, Blatt ER, et al. Limping child--ages 0-5 years. American College of Radiology (ACR). 2007. 5. [Full Text].

  8. Mistry RM, Lennon D, Boyle MJ, Chivers K, Frampton C, Nicholson R, et al. Septic Arthritis and Acute Rheumatic Fever in Children: The Diagnostic Value of Serological Inflammatory Markers. J Pediatr Orthop. 2014 Aug 13. [Medline].

  9. Horton DB, Strom BL, Putt ME, Rose CD, Sherry DD, Sammons JS. Epidemiology of Clostridium difficile Infection-Associated Reactive Arthritis in Children: An Underdiagnosed, Potentially Morbid Condition. JAMA Pediatr. 2016 May 16. e160217. [Medline].

  10. Deanehan JK, Kimia AA, Tan Tanny SP, Milewski MD, Talusan PG, Smith BG, et al. Distinguishing Lyme from septic knee monoarthritis in Lyme disease-endemic areas. Pediatrics. 2013 Mar. 131(3):e695-701. [Medline].

  11. Kelly JC. Septic Arthritis in Children Ruled Out by New Test. Medscape. Available at http://www.medscape.com/viewarticle/779584. Accessed: September 17, 2014.

  12. Carter K, Doern C, Jo CH, Copley LA. The Clinical Usefulness of Polymerase Chain Reaction as a Supplemental Diagnostic Tool in the Evaluation and the Treatment of Children With Septic Arthritis. J Pediatr Orthop. 2015 Apr 7. [Medline].

  13. Pääkkönen M, Kallio MJ, Peltola H, Kallio PE. Pediatric septic hip with or without arthrotomy: retrospective analysis of 62 consecutive nonneonatal culture-positive cases. J Pediatr Orthop B. 2010 May. 19(3):264-9. [Medline].

  14. Fogel I, Amir J, Bar-On E, Harel L. Dexamethasone Therapy for Septic Arthritis in Children. Pediatrics. 2015 Oct. 136 (4):e776-82. [Medline].

 
Previous
Next
 
Emergency room photograph of an infant with septic arthritis of the left hip. The child holds his hip rigidly in the classic position of flexion, abduction, and external rotation, a position that maximizes capsular volume. The patient is relatively comfortable as long as the hip joint remains immobile in this position.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.