antibiotics in osteomyelitis and septic arthritis

Last reviewed 06/2021

Consult expert advice.

Antibiotic treatment is usually necessary for up to 6 weeks in septic arthritis and 2-3 months in osteomyelitis.

• antibiotic regimen used is dictated by any local specific bacterial resistance
• antibiotic of choice should be able to treat Staph. aureus and other Gram-positive cocci in adults (e.g. flucloxacillin and fusidic acid, clindamycin; but Staph. aureus is exhibiting increasing resistance to ß-lactam antibiotics), H. influenzae in children under 3 years of age (e.g. amoxicillin, a cephalosporin such as cefotaxime or ceftriaxone) or Gram-negative organisms in the elderly and in those with predisposing diseases such as RA (e.g. a cephalopsorin such as cefotaxime or ceftriaxone)
• important not to start an antibiotic until bacterial culture samples have been taken and do not give the antibiotic by injection into the joint
• response to therapy may be judged by the clinical features, fever, acute phase markers (e.g. CRP), and white cell count

Note: these are merely guidelines; please check with local microbiological advice and the current issue of BNF.

Reference:

• (1) Axford JS. Joint and bone infections Medicine 2006;34 (10):405-412.