Arthritis, Septic and Osteomyletitis, Acute

Description

General Measures

Medicine Treatment

Referral

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ICD-10 Code: 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.

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

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GENERAL MEASURES

• Baseline X-ray.
• Rest and immobilisation.

Septic arthritis:

• Drainage is important. Discuss with an appropriate 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. 

LoE:II⁸

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

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

LoE:III⁹

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

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

AND

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

LoE:III¹⁰

Severe penicillin allergy: (Z88.0)
Refer.

Analgesia

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

LoE:I¹¹

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 in spite of adequate antibiotic therapy, a sub-periosteal abscess must be sought and drained by a specialist surgeon.
• Chronic osteomyelitis.
• Pathological fractures.

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Standard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Adults 2024 Edition