Bone and Joint Infections (Antimicrobial)
TAM (Treatments and Medicines) NHS Highland
The following advice applies to acute osteomyelitis and septic arthritis caused by haematogenous spread. It does not apply to infection by contiguous spread (eg related to chronic ulcers or trauma), to chronic infections, or where prosthetic material is present.
The following advice is for empiric therapy. Definitive therapy should be discussed with an infection specialist or paediatrician. It should usually be guided by joint aspirate or bone biopsy which should be taken before antibiotics are instituted where possible. For osteomyelitis and septic arthritis, consider referral to Outpatient Parenteral Antimicrobial Therapy (OPAT) service. Sodium fusidate must be avoided if the patient has been prescribed a statin due to increased risk of rhabdomyolysis.
SEEK ORTHOPAEDIC AND INFECTION SPECIALIST ADVICE EARLY
For glossary of terms see Glossary.
Drug details
Osteomyelitis
Staph aureus is the most common pathogen in children and adults
IV flucloxacillin 2g 4 times daily
4 to 6 weeks minimum with regular review. For childhood osteomyelitis, consider early oral switch. Choice of oral antibiotic should be individualised.
If penicillin allergy
IV Vancomycin - refer to NHS Highland vancomycin dosing guidelines
4 to 6 weeks minimum with regular review. For childhood osteomyelitis, consider early oral switch. Choice of oral antibiotic should be individualised.
Septic arthritis
Staph aureus and beta-haemolytic streptococci are the commonest pathogens. Seek Microbiology advice if at risk of sexually transmitted disease.
IV Flucloxacillin 2g 4 times daily
4 weeks. Consider possible IV to oral switch after 2 weeks.
Staph aureus requires 3 weeks.
If penicillin allergy or if MRSA is known or suspected
IV vancomycin - refer to NHS Highland vancomycin dosing guidelines
4 weeks. Consider possible IV to oral switch after 2 weeks.
Staph aureus requires 3 weeks.