Empirical therapy for postprocedural infections of the shoulder
For patients with postprocedural infections of the native shoulder joint who have sepsis or septic shock, treat as for Sepsis or septic shock associated with a bone or joint source.
The optimal antibiotic regimen for postprocedural infections of the native shoulder joint has not been established, but an antibiotic with activity against C. acnes is recommended for empirical treatment. Modify therapy according to the results of culture and susceptibility testing.
For patients with native joint septic arthritis of the shoulder, while awaiting microbiology results, the following regimen may be suitable:
cefazolin 2 g (child: 50 mg/kg up to 2 g) intravenously, 8-hourly. For dosage adjustment in adults with kidney impairment, see cefazolin dosage adjustment. See advice in Directed therapy for postprocedural infections of the shoulder caused by Cutibacterium acnes. cefazolin cefazolin cefazolin
For patients who have had a nonsevere (immediate or delayed) hypersensitivity reaction to a penicillin, use cefazolin (as above).
For patients who have had a severe immediate1 hypersensitivity reaction to a penicillin, cefazolin (at the dosage 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 is not used, or for patients who have had a severe delayed2 hypersensitivity reaction to a penicillin, use:
vancomycin intravenously; for initial dosing, see Intermittent vancomycin dosing for noncritically ill adults or Intermittent vancomycin dosing for young infants and children. See advice in Directed therapy for postprocedural infections of the shoulder caused by Cutibacterium acnes. vancomycin vancomycin vancomycin