Intravenous to oral switch and duration of therapy for native joint septic arthritis

The suggested duration of antibiotic therapy for septic arthritis, including the minimum duration of intravenous therapy, is outlined in Suggested duration of antibiotic therapy for native joint septic arthritis.

For patients who are clinically stable, evidence supports an earlier switch to oral therapy, as well as a shorter total duration of therapy (intravenous + oral), than previously recommended¹ – these shorter durations are reflected in Suggested duration of antibiotic therapy for native joint septic arthritis. Expert advice should guide when to switch to oral therapy and the choice of regimen. Multidisciplinary specialist discussion may be necessary. Factors to consider includeLi, 2019McMullan, 2016:

• the adequacy of surgical drainage and irrigation of the infected joint
• the location of infection – shorter durations of therapy may be appropriate for infections of the hand or wrist (see Bone and joint infections of the hand)
• the presence of a concomitant infection that requires a longer course of intravenous therapy (eg Staphylococcus aureus bacteraemia, infective endocarditis, spinal epidural abscess, adjacent osteomyelitis)
• the patient’s suitability for oral therapy, including being
  • clinically stable
  • able to tolerate oral intake with no concerns about malabsorption
  • likely to adhere to oral therapy
• the availability of an oral antimicrobial that meets the following criteria
  • treats the identified or expected organism
  • has good bioavailability and is able to be given at a high enough dose to achieve adequate exposure at the target site for the relevant organism – see Oral and enteral route of administration for antimicrobials
  • is palatable and available in a suitable formulation (eg a paediatric formulation for children).

Ambulatory antimicrobial therapy may be appropriate in carefully selected patients.