Directed therapy for postprocedural infections of the shoulder caused by Cutibacterium acnes
For directed therapy of postprocedural infections of a native shoulder joint, if Cutibacterium acnes is identified and benzylpenicillin susceptibility is confirmed, use:
benzylpenicillin 1.2 g (child: 50 mg/kg up to 1.2 g) intravenously, 6-hourly. For dosage adjustment in adults with kidney impairment, see benzylpenicillin dosage adjustment. See advice in Intravenous to oral switch and duration of therapy for native joint septic arthritis. benzylpenicillin benzylpenicillin benzylpenicillin
When it is appropriate to switch to oral therapy, use:
amoxicillin 1 g (child: 25 mg/kg up to 1 g) orally, 8-hourly. For dosage adjustment in adults with kidney impairment, see amoxicillin dosage adjustment. For the duration of oral continuation therapy, see Suggested duration of antibiotic therapy for native joint septic arthritis. amoxicillin amoxicillin amoxicillin
For patients who have had a hypersensitivity reaction to a penicillin in whom C. acnes is identified and clindamycin susceptibility is confirmed, use:
clindamycin 600 mg (child: 15 mg/kg up to 600 mg) intravenously, 8-hourly. See advice in Intravenous to oral switch and duration of therapy for native joint septic arthritis. clindamycin clindamycin clindamycin
When it is appropriate to switch to oral therapy, use:
clindamycin 450 mg (child: 10 mg/kg up to 450 mg) orally, 8-hourly. For the duration of oral continuation therapy, see Suggested duration of antibiotic therapy for native joint septic arthritis. clindamycin clindamycin clindamycin
For culture-proven C. acnes infection, adding rifampicin to the treatment regimen is unlikely to provide benefitJacobs, 2016.