Septic Arthritis of Native Joints Empiric Therapy
Updated: Oct 02, 2020
Author: John L Brusch, MD, FACP; Chief Editor: Michael Stuart Bronze, MD
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.. 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)
Gram-positive cocci in clusters
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)
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:
-
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
Human, dog, or cat bite
See the list below:
-
Ampicillin-sulbactam 1.5-3 g IV q6h
Questions & Answers
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?
