Acute osteomyelitis is a bone infection with symptoms lasting days or a few weeks, commonly caused by methicillin-susceptible or resistant S. aureus. Common etiologies of septic arthritis include N. gonorrhea, S. aureus, Streptococcus species, and Gram-negative bacilli.
|Preferred antibiotic choice(s)|
|For the empiric treatment of acute osteomyelitis or septic arthritis:|
|Cloxacillin (IV)||Powder for injection: 500 mg (as sodium salt) in vial.||2 g 6 hourly||4 – 6 weeks|
|Alternative antibiotic choice(s)|
|Ceftriaxone (IV)||Powder for injection: 250 mg; 1 g (as sodium salt) in vial||1 g daily||4 – 6 weeks|
|Cefotaxime (IV)||Powder for injection: 250 mg per vial (as sodium salt||2 g 8 hourly|
|Amoxicillin + clavulanic acid (IV)||Powder for injection: 500 mg (as sodium) + 100 mg (as potassium salt); 1000 mg (as sodium) + 200 mg (as potassium salt) in vial||1 g Amoxicillin component 8 hourly|
|For the treatment of monoarticular septic arthritis with STD risk|
|Ceftriaxone (IV)||Powder for injection: 250 mg; 1 g (as sodium salt) in vial||1 g daily||2 weeks|
|In case of confirmed drug allergy or medical contraindication|
|Clindamycin (IV)||Clindamycin- Injection: 150 mg (as phosphate)/mL; Oral liquid: 75 mg/5 mL (as palmitate)||600 mg 8 hourly||2 weeks|
Principles of Stewardship:
- Do not give empirical antibiotics for chronic bone and joint infections. Instead, conduct bone and tissue biopsies, and treat with directed therapy.
- For septic arthritis, conduct a joint culture before administering antibiotic therapy and refer to an orthopedic surgeon for assessment.
- If patient cannot take oral antibiotics, start with IV antibiotics and switch to oral therapy as soon as patient is able to take antibiotics orally.
- Adequate drainage of purulent joint fluid is needed in addition to antibiotic therapy for septic arthritis.