Advances in the Management of Bacterial Septic Arthritis

Myo M Lynn; Catherine J Mathews

Disclosures

Int J Clin Rheumatol. 2012;7(3):335-342. 

In This Article

Current Treatment of Bacterial Septic Arthritis

Prompt initiation of appropriate antibiotic therapy and drainage of purulent material remains the mainstay of treatment of bacterial septic arthritis.[16] As there are no randomized controlled trials regarding the duration and choice of antibiotic regimen to date, most published guidelines on the initial empirical choice of antibiotic therapy depend on the individual risk factors for the patient, local drug resistance and the geographic variation of pathogens.[16] Treatment regimes need to be modified depending on subsequent identification of organisms. In the UK, 2 weeks duration of initial antibiotic therapy is recommended with follow-up of at least 4 weeks of oral antibiotics. Antibiotics are advised to be continued until symptoms and signs resolve and the inflammatory markers normalize.[23] Table 1 shows a summary of current UK recommendations for initial antibiotic choice in suspected septic arthritis.[23]

In a recent survey of UK-based rheumatologists and orthopedic surgeons (74 rheumatologists and 77 orthopedic surgeons, total 151), the vast majority of clinicians (80% of rheumatologists and 82% of orthopedic surgeons) reported that they would use antibiotics for a minimum of 6 weeks including 2 weeks of intravenous therapy in the treatment of bacterial septic arthritis. The majority would seek microbiological advice to guide their treatment. However, only 7% of rheumatologists and 4% of orthopedic surgeons would continue antibiotics until inflammatory markers normalized.[43]

Combined with antibiotics, removal of septic material from the joint space is mandatory in the management of septic arthritis.[16,44] Either arthroscopic washout, open drainage or repeated closed needle aspiration can be used. According to the UK survey already quoted, 76% of rheumatologists and 65% of orthopedic surgeons would prefer to employ an arthroscopic washout. 22% of rheumatologists and 27% of orthopedic surgeons would prefer closed-needle aspiration. Only a minority of doctors would prefer an open joint washout.[43] In reality, so far, there is no randomized controlled trial with results that can identify which method is superior.[45]

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