Hospital empirical antimicrobial therapy for adults
Acute Osteomyelitis / Acute septic arthritis*
Before proceeding, read the empirical therapy - general notes section.
Notes
- *Septic arthritis - refer to orthopaedics for emergency drainage prior to initiation of antibiotics where possible
- MRSA should be considered if the patient has been in hospital within the last six months
- Send blood and if appropriate bone/joint fluid for culture
Likely organism
Staphylococcus aureus
Streptococcus pyogenes
Streptococcus pyogenes
1st choice antibiotic
Flucloxacillin 2g IV every 6 hours, initially, when appropriate switch to oral therapy, 500mg orally four times daily
+/-
Rifampicin 300-600mg IV or orally every 12 hours
+/-
Rifampicin 300-600mg IV or orally every 12 hours
Add rifampicin for prosthetic joints after consultation with specialist
2nd choice antibiotic
In penicillin allergy:
Comments
Treatment duration 4-6 weeks (usually 2 weeks IV followed by 4 weeks orally)
If MRSA likely use Vancomycin IV per
protocol as first-choice
If MRSA likely use Vancomycin IV per
protocol as first-choiceBack to antimicrobial empirical therapy for musculoskeletal infections webpage