What are the treatment options for septic arthritis if antibiotic therapy fails?

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

If, after 5 days of therapy, the joint shows some degree of improvement, consider an empirical trial of an anti-inflammatory agent for increased symptomatic relief. If the joint fails to respond after 5 days of appropriate antibiotic therapy (eg, presence of clinically significant fever, continued synovial purulence, persistently positive findings on culture), reassess the therapeutic approach, as follows:

  • Reculture the fluid and reexamine for crystals
  • Perform appropriate serologies for diagnosis of Lyme disease; if these are positive, treat per current guidelines
  • If fungal or mycobacterial infection is possible, consider obtaining a synovial biopsy
  • Consider the possibility of reactive arthritis; nonsteroidal inflammatory agents (NSAIDs) are the primary therapeutic agents for reactive arthritis
  • Perform imaging studies, either radiographs or magnetic resonance imaging (MRI), to rule out periarticular osteomyelitis.

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