From the Research
For empiric treatment of septic arthritis, oral antibiotics can be given in most cases because they are not inferior to intravenous therapy, and the recommended regimen should cover common causative organisms such as Staphylococcus aureus. The choice of oral antibiotic should be based on the suspected or confirmed pathogen, as well as local resistance patterns. According to the most recent and highest quality study 1, Staphylococcus aureus is the most common pathogen isolated in septic arthritis.
Key Considerations
- The total duration of therapy ranges from two to six weeks, depending on the specific infection and patient response 1.
- Consideration for microorganisms such as Neisseria gonorrhoeae, Borrelia burgdorferi, and fungal infections should be based on history findings and laboratory results 1.
- Joint drainage through arthrocentesis, arthroscopy, or open surgical drainage is essential alongside antibiotics to prevent joint destruction and permanent disability.
Oral Antibiotic Options
- For methicillin-sensitive S. aureus, dicloxacillin 500 mg orally four times daily can be considered.
- For MRSA, trimethoprim-sulfamethoxazole DS (1-2 tablets) twice daily can be considered.
- In cases where the pathogen is susceptible, fluoroquinolones like levofloxacin can be an option for oral therapy, as seen in a case report of gonococcal septic arthritis 2.
Monitoring and Adjustment
- Patients should be monitored for clinical improvement, including decreased pain, swelling, and improved range of motion, as well as normalization of inflammatory markers like ESR and CRP.
- Therapy can be adjusted based on culture results and clinical response, allowing for the transition from broad-spectrum coverage to more targeted therapy.