Septic Arthritis Suspected — Antibiotics — Clinical Pathway: Emergency

Septic Arthritis Clinical Pathway — Emergency Department

Antibiotic Recommendations

Indication First-Line Therapy Allergy to First-Line β-Lactam
Assess Need for Alternative		 Comments
Suspected Septic Arthritis
  • Cefazolin, IV
  • 35 mg/kg/dose every 8 hours; maximum: 2,000 mg/dose
  • If MRSA risk factor(s) present:
    • Clindamycin, IV
    • 14 mg/kg/dose every 8 hours; maximum: 900 mg/dose
  • If prior history of clindamycin-resistant MRSA, therapy guided by prior isolate’s susceptibility
  • MRSA risk factors include:
    • History of prior MRSA infection or carriage
    • Known close/household contact with MRSA
    • Use of IV drugs
  • Clindamycin, IV
    • 14 mg/kg/dose every 8 hours; maximum: 900 mg/dose
  • Patients with sepsis should be treated per Sepsis, ED, Inpatient, PICU Pathway
    • Target pathogens:
      • Staphylococcus aureus
      • Streptococcus pyogenes (Group A Streptococcus)
      • Kingella kingae
Synovial Fluid Positive for Gram Negative Organism
  • Ceftriaxone, IV
  • 50 mg/kg/dose every 24 hours; maximum: 2,000 mg/dose
  • Suggest ID consult
 Contact ID consult  

CHOP Formulary for complete drug information.