What is the treatment for septic arthritis?

From the Guidelines

Septic arthritis treatment requires prompt medical attention and typically involves a combination of joint drainage and antibiotic therapy, with a recommended duration of antibiotic therapy of 2-4 weeks, as suggested by the most recent and highest quality study 1.

Key Components of Treatment

• Joint drainage: The infected joint should be drained either through needle aspiration, arthroscopy, or open surgical drainage to remove purulent material and reduce damage to the joint, as recommended by 1 and 1.
• Antibiotic therapy: Empiric antibiotic therapy should begin immediately after obtaining joint fluid and blood cultures, with initial regimens typically including vancomycin for potential MRSA coverage plus either ceftriaxone or cefepime for gram-negative coverage.
• Duration of antibiotic therapy: A 2-4 week course of therapy is suggested, as indicated by 1 and supported by the findings of 1, which compared 2 versus 4 weeks of antibiotic therapy after surgical drainage and found no significant difference in complete microbiologic remission.
• Supportive measures: Pain management, joint immobilization during the acute phase, and subsequent physical therapy to restore joint function are essential components of treatment.

Important Considerations

• Prompt treatment is essential to prevent permanent joint damage, with outcomes depending on the causative organism, patient factors, and time to treatment initiation.
• Antibiotic selection should be refined based on culture results, and transition to oral antibiotics is possible after clinical improvement.
• Children may require different antibiotic regimens tailored to their age and likely pathogens.
• The most recent and highest quality study 1 provides the best evidence for guiding treatment decisions, and its findings should be prioritized in clinical practice.

From the Research

Treatment Overview

• The treatment for septic arthritis typically involves a combination of medical and surgical interventions, tailored to the severity of the infection, the causative pathogen, and the overall condition of the patient 2.
• Medical treatment is not inferior to surgical treatment, but approximately 30% of patients with septic arthritis ultimately require surgical intervention 2.

Medical Treatment

• Antibiotic courses of 3 to 4 weeks in duration are usually adequate for uncomplicated bacterial arthritis 3.
• Treatment duration should be extended to 6 weeks if there is imaging evidence of accompanying osteomyelitis 3.
• Intraarticular antibiotic administration, such as vancomycin and teicoplanin, can be effective in the treatment of methicillin-resistant Staphylococcus aureus (MRSA) septic arthritis 4.

Surgical Treatment

• Surgical debridement, either open or arthroscopic, is often necessary to evacuate the joint and remove infected tissue 2, 3, 5.
• Continuous local antibiotic perfusion (CLAP) has been shown to be a promising option for managing septic arthritis of the shoulder caused by methicillin-resistant bacteria 6.
• Aspiration and tailored antibiotics can be effective in patients who are unable to undergo surgical debridement 5.

Specific Considerations

• The treatment of septic arthritis should be guided by the results of bacterial cultures and antibiotic susceptibility testing 2, 3.
• The use of systemic vancomycin or teicoplanin is the first-line treatment method in MRSA septic arthritis 4.
• A high index of suspicion is required to diagnose septic arthritis, particularly in patients with risk factors such as age, comorbid conditions, and recent joint surgery or injection 2, 5.