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]
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.. However, the specificity of PCT is quite low. There is growing interest in the diagnostic usefulness of C-reactive protein (CRP), whose value will likely be in documenting therapeutic response through serial measurements.[11]
Vancomycin 15 mg/kg IV q12h plusceftriaxone 1 g IV q24h (or cefepime 1-2 g IV q8h if Pseudomonas is suspected)
See the list below:
Vancomycin 15 mg/kg IV q12h
Cefazolin 1 g q8h (if MRSA nasal swab results are negative and patient is not septic)
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)
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)
See the list below:
Ceftriaxone 1 g IV q24h or
Cefepime 2 g IV q8h or
Piperacillin-tazobactam 3.375-4.5 g IV q6-8h or
Aztreonam 1-2 g IV q8h or
Ciprofloxacin 400 mg IV or 750 mg PO q12h or
Levofloxacin 750 mg IV or PO q24h
See the list below:
Ampicillin-sulbactam 1.5-3 g IV q6h
Overview
What is empiric therapy for septic arthritis of native joints?
What is the workup and treatment of Gram stain negative septic arthritis of native joints?
What are empiric therapy regimens for Gram-negative cocci septic arthritis of native joints?
What are empiric therapy regimens for Gram-negative rod septic arthritis of native joints?