What are the treatment options for native joint infections of septic arthritis?

Updated: Sep 03, 2019
  • Author: John L Brusch, MD, FACP; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

In native joint infections, antibiotics usually need to be administered parenterally for at least 2 weeks. However, each case must be evaluated independently. The medical dogma that infection with either methicillin-resistant S aureus (MRSA) or methicillin-susceptible S aureus (MSSA) requires at least 4 full weeks of intravenous has recently been challenged. In a randomized controlled study of 1,054 patients, 61% had hardware-associated infections, 38% infected with S aureus and 27% infected with CONS. Either oral or intravenous antibiotic therapy was begun within 7 days of surgery or the start of antibiotic therapy and administered for at least 6 weeks. At the end of one year, therapy failed in 50% of the IV group and 13% of the oral group. [39] The oral agents were generally quinolones or penicillins. Intravenous agents were glycopeptides and cephalosporins. More data are emerging to support shortened antibiotic courses for septic arthritis of native joints. [40]

Caveats to this shortened course of IV antibiotic therapy include the presence of extensive periarticular osteomyelitis, leukopenia, or other immunosuppressive states. In patients with blood cultures that are positive for S aureus, it is imperative to exclude underlying valvular infection. Measuring the response of various inflammatory markers must be strongly considered to augment the clinical response to antibiotic treatment.


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