Antibiotic Guideline for the Empirical Treatment of Sepsis:

Bone and Joint infections:

• Joint aspiration and or deep bone specimens for Gram stain and culture (prior to treatment if possible) are mandatory to establish diagnosis and further management.  If unable to obtain a specimen, contact the on-call rheumatologist or orthopaedic surgeon.
• Flucloxacillin IV 2g qds covers both Meticillin sensitive S.sureus and streptococcal infections
• Penicillin allergy:  Clindamycin IV 600mg qds (change to oral when medically stable) OR Cefuroxime IV 1.5g tds (not if serious penicillin allergy e.g. urticarial rash within the first 72 hours, anaphylaxis or angioedema)

If  MRSA infection is a possibility:

• Vancomycin 1g bd and monitor levels (reduce dose if >65 years old or renal impairment to 1g od)

PLUS Cefuroxime IV 1.5g tds (not to be used in serious penicillin allergy) 

If suspected / proven Gram negative infection (elderly patients and /or immunocompromised)

• Cefuroxime IV 1.5g tds (not in severe Penicillin allergy)
• If risk of multi resistant gram negatives discuss treatment with the microbiologist

If suspected/proven gonococcal infection

• Ceftriaxone IV 1g od (Not in serious Penicillin allergy)

Further therapy

Further therapy should be discussed with a medical microbiologist as antibiotic choice will need to be modified following the results of the Gram stain and culture. Staphylococcal bone and joint infections are commonly treated with more than one agent. If infection is confirmed the treatment is usually given for a total of 4-6 weeks of which 2 weeks is given IV.

Click here for full guideline.

Caution; the antibiotic doses recommended on this website are intended for adult patients with normal renal and liver function unless otherwise stated. Dosing advice for patients with renal impairment is available here.

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