Treatment

Patients with suspected septic arthritis should be referred urgently and immediately for hospital specialist review

• synovial fluid should be obtained - for gram-staining, culture and crystal analysis
• following joint aspiration, empirical IV antibacterial therapy should be commenced - coverage should be for staphylococci and streptococci in adults, and, additionally, Haemophilus in children; the regimen can be modified in the light of culture and sensitivity results. Treatment should be given for several weeks but the optimal duration of therapy is unknown
• where the joint is accessible - needle aspiration should be used to decompress the joint
• surgical drainage is indicated, using either arthroscopy (particularly useful for the knee) or athrotomy (particularly useful for the shoulder or hip) if aspiration is required more than 3 times per day, or if adjacent soft tissue is affected, or if there is no response to 5 days of aspiration plus antibacterial therapy, or if the joint is difficult to aspirate (1)

Reference:

1. Drug and Therapeutics Bulletin (2003), 41 (9), 65-7.