Acute Osteomyelitis / Septic Arthritis / Discitis

Micro-organism

Staph. aureus, Streptococcal Spp., gram negative organisms incl Pseudomonas spp.

First Line

Flucloxacillin IV + Gentamicin IV

Septic arthritis - treat for 4-6 weeks

Osteomyelitis - treat for 6 weeks

 

Second line: mild intolerance or mild skin reaction

Cefotaxime IV or ceftriaxone IV + gentamicin IV

Septic arthritis - treat for 4-6 weeks

Osteomyelitis - treat for 6 weeks

Anaphylaxis (including severe skin reactions) to penicillin / cephalosporins or MRSA suspected

Vaoncomycin IV + Gentamicin IV

Septic arthritis - treat for 4-6 weeks

Osteomyelitis - treat for 6 weeks

Notes

Pseudomonas likely in feet infections and sickle cell anaemia at any age

Review antibiotic choice once sensitivities available

IV therapy is usually continued for up to 14 days before IV to oral switch - discuss with microbiology / orthopaedics / paediatrics