Acute osteoarticular infection, including septic arthritis and acute osteomyelitis
- Consult paediatric ID for all cases.
- Review antibiotic choice once microbiology results available.
- Initial oral therapy should be considered for all patients (unless complex or features of high risk disease)
- For complex or high risk disease, initial antibiotics should be administered IV, often for a longer duration (i.e. Up to 2 weeks). Complex/high risk disease includes:
- Multifocal site
- Significant bone destruction,
- Significant immunosuppression
- Significant soft tissue infection
- Sepsis/shock or less than 3 months of age
A review should be undertaken at 48-72 hours to ensure pain improvement, decreasing inflammatory markers and resolution of fever. IV to oral switch should be considered at that stage, if patient not already on oral antibiotics.
Typical duration of therapy for respective indications:
Septic Arthritis: 10-14 days
Osteomyelitis: 3-4 weeks (may require up to 6 weeks if complex infection)
Pyomyositis: 2-3 weeks
Discitis: 4 weeks
Preferred including penicillin (non-severe) allergy
cefalexin po see dosing table below
If high risk/complex disease or unable to tolerate orals: cefazolin 50mg/kg/dose (Max 2g) iv TDS
- Oral switch at 48-72 hours if clinical and biochemical improvement: Switch to cefalexin po tds (see dosing table below)
- If unable to switch to oral therapy: Ambulate with ceftriaxone 80mg/kg (Max 4g) iv OD (if over 1 month old)
cefalexin oral dosing table:
|
Weight |
cefalexin oral dosing |
|
Less than 15 kg |
33 mg/kg po TDS |
|
15 to 20 kg |
500mg po TDS |
|
21 to 30 kg |
750mg po TDS |
|
31 to 40 kg |
1g po TDS |
|
Over 40 kg |
1g po QDS |
For penicillin allergy (severe) or MRSA patients
co-trimoxazole 27 mg/kg (Max 1.44g) iv BD
Oral switch at 48-72 hours if clinical and biochemical improvement: Switch to oral co-trimoxazole (see dosing table below) if susceptibilities allow:
|
Age |
co-trimoxazole oral dose |
|
6 Weeks to 5 years |
24mg/kg BD |
|
6 Years to 11 years |
24mg/kg (max 960mg) BD |
|
12 years to 17 years |
960mg BD |