Septic Arthritis
MSSA/MRSA, S. pyogenes, Kingella kingae (age < 5y)
Unimmunized patients consider: Streptococcus pneumoniae, Haemophilus influenzae type B
In a sexually active patient consider: Neisseria gonorrhea
Clindamycin 40mg/kg/day IV/PO div q8h (max 600mg/dose)¹
Gonococcal arthritis/tenosynovitis:
Ceftriaxone 50mg/kg/dose IV/IM q24h x 7 days (max 1000mg/dose)
AND
Azithromycin 20mg/kg PO (max 1000mg/dose) as a single dose to reduce development of resistance¹
Empiric Therapy & Alternative Regimens
Duration of Therapy & Clinical Pearls
Consult Infectious Diseases and Orthopedics.
Synovial fluid aspirate cell counts with differential and synovial fluid culture and blood culture should be obtained prior to starting antibiotics if safe for patient.
IV to PO transition:
Consider once afebrile, clinically improved, CRP decreasing. PO regimen will depend on whether a pathogen was isolated from blood/joint aspirate and should be tailored to the narrowest possible spectrum.³
Length of Therapy (Total IV + PO):
14-21 days³