Empirical therapy for suspected gram-negative septic arthritis of a native joint

The regimens below are recommended for the empirical treatment of native joint septic arthritis when a gram-negative organism has been identified on Gram stain of a joint aspirate.

For patients with sepsis or septic shock, treat as for Sepsis or septic shock associated with a bone or joint source.

In infants and children younger than 4 years, cefazolin is an appropriate agent because infection with Kingella kingae is most likely; use:

cefazolin 50 mg/kg up to 2 g intravenously, 8-hourly. See advice on Intravenous to oral switch and duration of therapy for native joint septic arthritis. cefazolin

In adults and children 4 years and older, use:

1ceftriaxone 2 g (child: 50 mg/kg up to 2 g) intravenously, daily. See advice in Intravenous to oral switch and duration of therapy for native joint septic arthritis ceftriaxone ceftriaxone ceftriaxone

OR

1cefotaxime 2 g (child: 50 mg/kg up to 2 g) intravenously, 8-hourly. For dosage adjustment in adults with kidney impairment, see cefotaxime dosage adjustment. See advice in Intravenous to oral switch and duration of therapy for native joint septic arthritis. cefotaxime cefotaxime cefotaxime

For patients who have had a nonsevere (immediate or delayed) hypersensitivity reaction to a penicillin, use cefazolin, ceftriaxone or cefotaxime (see dosages above).

For patients who have had a severe immediate1 hypersensitivity reaction to a penicillin, cefazolin, ceftriaxone or cefotaxime (at the dosages above) can be considered if a beta-lactam antibiotic is strongly preferred (for considerations, see Severe immediate hypersensitivity: Implications of cross-reactivity between penicillins and cephalosporins).

For patients who have had a severe immediate1 hypersensitivity reaction to a penicillin in whom cefazolin, ceftriaxone or cefotaxime is not used, or for patients who have had a severe delayed2 hypersensitivity reaction to a penicillin, seek expert advice.

Modify therapy according to the results of culture and susceptibility testing. For suggested regimens, see:

1 Severe immediate hypersensitivity reactions include anaphylaxis, compromised airway, airway angioedema, hypotension and collapse.Return
2 Severe delayed hypersensitivity reactions include cutaneous adverse drug reactions (eg drug rash with eosinophilia and systemic symptoms [DRESS], Stevens–Johnson syndrome/toxic epidermal necrolysis [SJS/TEN], severe blistering or desquamative rash), and significant internal organ involvement (eg acute interstitial nephritis).Return