Septic Arthritis of Native Joints Empiric Therapy 

Updated: Nov 07, 2018
  • Author: John L Brusch, MD, FACP; Chief Editor: Michael Stuart Bronze, MD  more...
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Empiric Therapy Regimens

Empiric therapy should be guided by results of synovial fluid Gram staining. Initial therapy should consist of IV antibiotics. [1] The duration of empiric therapy depends on the determination of the specific etiology. [2, 3, 4, 5, 6, 7, 8]

Gram stain negative or unavailable

Diagnosis of the septic joint is challenging in patients with underlying inflammatory disease and a negative Gram stain. [9] In these cases, measurement of serum procalcitonin (PCT) should be considered. [10] This test appears to be more useful in ruling in than in excluding the diagnosis of septic arthritis. [11] Recently, it has been demonstrated that the specificity of PCT is quite low.

Vancomycin 15 mg/kg IV q12h plus ceftriaxone 1 g IV q24h (or cefepime 1-2 g IV q8h if Pseudomonas is suspected)

Gram-positive cocci in clusters

See the list below:

  • Vancomycin 15 mg/kg IV q12h

Gram-positive cocci in chains

See the list below:

  • Ampicillin 2 g IV q4h or

  • Ceftriaxone 1 g IV q24h or

  • Vancomycin 15 mg/kg IV q12h (if patient is allergic to penicillin)

Gram-negative cocci

See the list below:

  • Ceftriaxone 1 g IV q24h or

  • Ciprofloxacin 400 mg IV or 500 mg PO q12h (only if susceptibility testing will be available)

Gram-negative rods

See the list below:

Human, dog, or cat bite

See the list below: