Arthritis, septic and osteomyelitis, acute

M00.90-99/M86.10-19

DESCRIPTION

Septic arthritis is typically an acute infective condition involving one or more joints. The joint is hot, swollen, very painful on movement, and with restricted movements.

Acute osteomyelitis typically involves the long bones or the vertebrae.

Signs of systemic infection are usually present. The infection is usually bloodborne, but may follow trauma. The course may be acute or protracted. The commonest causative organism is Staphylococcus aureus. N. gonorrhoeae is an important cause of septic arthritis.

Note: Acute gout and haemophiliacs with bleeding into joints may mimic septic arthritis.

GENERAL MEASURES

Baseline X-ray.

Rest and immobilisation.

Septic arthritis: Drainage is important. Discuss with a specialist

MEDICINE TREATMENT

Empiric antibiotic therapy

Therapy is directed against S. aureus unless there is evidence of urethritis or PID, in which case gonococcal infection should be covered.

It is crucial to obtain cultures of blood, joint or aspirate of osteomyelitis focus before administering antibiotics.

  • Cefazolin, IV, 2 g 8 hourly for 4 weeks.

After 2 weeks of IV therapy, a change to oral therapy may be considered in patients with a good clinical response:

LoEII [8]

  • Flucloxacillin, oral, 1 g 6 hourly to complete the 4 weeks’ treatment.

Severe penicillin allergy: (Z88.0)

  • Clindamycin, IV, 600 mg 8 hourly.

After 2 weeks of IV therapy, a change to oral therapy may be considered in patients with a good clinical response:

  • Clindamycin, oral, 450mg 8 hourly to complete the 4 weeks’ treatment.

LoEIII [9]

For gonococcal arthritis A54.4+ + (M01.30-39*)

  • Ceftriaxone, IV, 1 g daily for 1 week.

LoEIII [10]

AND

  • Azithromycin, oral, 1 g, as a single dose.

Severe penicillin allergy: (Z88.0)

Refer.

Analgesia

LoEI [11]

  • NSAID, e.g.:
  • Ibuprofen, oral, 400 mg 8 hourly with meals.

AND/OR

  • Paracetamol, oral, 1 g 4–6 hourly when required.
    • Maximum dose: 15 mg/kg/dose.
    • Maximum daily dose: 4 g in 24 hours.

REFERRAL

  • Acute osteomyelitis/ septic arthritis for early drainage by specialist surgeon.
  • If pyrexia persists despite adequate antibiotic therapy, a sub-periosteal abscess must be sought and drained by a specialist surgeon.
  • Chronic osteomyelitis.
  • Pathological fractures.