Septic Arthritis of Native Joints Empiric Therapy 

Updated: Oct 02, 2020
  • Author: John L Brusch, MD, FACP; Chief Editor: Michael Stuart Bronze, MD  more...
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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 plus ceftriaxone 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:

Human, dog, or cat bite

See the list below: