Warning

Do not start antibiotic therapy until samples obtained.

Discuss all cases with microbiology and orthopaedics/rheumatology

Required investigations

  • Blood cultures x 2 sets from separate sites
  • Joint aspirate fluid sent for culture (contact microbiology to arrange urgent Gram stain)

Antibiotic recommendation

Recommended total duration: 4 weeks

Recommended antibiotic Flucloxacillin 2g every 6 hours IV
Penicillin Allergy OR previous MRSA colonisation or infection

Vancomycin IV (use NHS Lothian Calculator on AMT intranet page); aim trough levels 15-20mg/L

These groups are at a higher risk of Gram-negative infection

  • elderly
  • frail
  • recurrent UTI
  • recent urological or abdominal surgery

Discuss with microbiology early if concerns regarding Gram negative infection.

CONSIDER

Gentamicin IV Use NHS Lothian Calculator located AMT intranet page

IV to oral switch

Depends on microbiological investigations and whether septic arthritis is confirmed

Notes

  • Intravenous therapy recommended for a prolonged proportion of treatment.
  • In stable patients consider referral to OPAT.
  • Likely organisms: Staphylococcus aureus, Streptococci, Enterobacteriacae, Neisseria gonorrhoea
  • Where gonococcal infection is suspected take appropriate samples (genital, urine, throat, rectal as required) for combined Chalmydia/Gonorrohoeal NAAT testing (get the right sampling kit) -  joint fluid can be tested by PCR for gonorrhoea in discussion with microbiology.

Editorial Information

Last reviewed: 24/04/2024

Next review date: 01/04/2027

Author(s): Clark Russell, ST6 Infectious Diseases, Simon Dewar, Lead clinician AMT.