Page 43 - HPP ANTIMICROBIAL GUIDELINE 2018

Suggested Treatment
Infection/ Condition Comments
Preferred Alternative

Acute monoarticular septic arthritis Cloxacillin 2gm IV q 4-6h Duration for pyogenic septic arthritis:
• Parenteral therapy 2 to 4 weeks
then step down to appropriate oral
therapy
• Treatment duration: 4- 6 weeks

Drainage, debridement and washout
of infected joint is important to limit
further damage

PROSTHETIC JOINT INFECTIONS

Early: <3 months after surgery Empirical therapy is not recommended Duration of treatment should be
individualized according to treatment
Delayed onset :from 3 to 12 months after Treatment is based on culture and sensitivity strategy/ approach
surgery

Late Onset : >12 months after surgery Rifampicin should never be used alone and should start only after
clearance of bacteraemia if applicable
Definite Prosthetic Joint infection
Methicillin sensitive Staphylococcus Cloxacillin 2gm IV q4-6h Duration of treatment according to
aureus PLUS /MINUS treatment strategy
OR Rifampicin (10-15mg/kg/day) Intravenous treatment should be
Cefazolin 2gm IV q8h 450mg - 600mg PO q24h given for 2-6 weeks before stepping
down to oral combination therapy
according to susceptibility

Methicillin resistant Staphylococcus Vancomycin 15-20mg/kg IV q12h PLUS /MINUS Rifampicin should be included in the
aureus Rifampicin (10-15mg/kg/day) intensive and oral maintenance
450mg - 600mg PO q24h therapy if implant is retained and
after blood culture clearance

HPP AMG Bone & Joints Infections 16