Clinical definition:
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) | |||
| Drug | Formulation | Dosage | Duration |
| 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.
Notes:
- Adequate drainage of purulent joint fluid is needed in addition to antibiotic therapy for septic arthritis.