Bone and Joint

Microbiological specimens

• Joint aspirates
• Synovial Tissue/Bone (operative sample)
• Blood Culture
• If GC STD samples as directed by GUM
• The choice of agent should take into account the patient's risk for C. difficile infection

Antibiotic - 1st line
Flucloxacillin 2g q6h IV

2nd Line
Clindamycin 600mg q6h IV.

Antibiotic - 1st line
Flucloxacillin 2g q6h IV.

2nd Line
Clindamycin 600mg q6h IV.

Antibiotic - 1st line
Empiric treatment not indicated.
If acute exacerbation, treat as acute osteomyelitis.

Antibiotic - 1st line
Discuss between primary consultant and Consultant Microbiologist

Antibiotic - 1st line
Vancomycin IV (dosed as per trust vancomycin guideline)

2nd Line
Clindamycin 600mg q6h IV.

Antibiotic - 1st line

Flucloxacillin 1g q6h IV
plus
Metronidazole 500mg q8h IV
plus
Gentamicin (click here for full gentamicin policy)
Note: If serum creatinine is not yet known then 5mg/kg may still be initiated unless 70years or above or there is evidence of existing severe renal impairment. CrCl must still be calculated once U+Es are available. ALL SUBSEQUENT DOSES MUST BE ADJUSTED AS PER CrCl once known. Must check pre-dose level as per policy.

5mg/kg IV q24h (max 500mg): if <70 years and CrCl≥30mL/min  or
3mg/Kg IV q24h (max 300mg): If ≥70 years or CrCl 10-29.9ml/min, known renal impairment, or clinician has concerns about higher dose (e.g. clinical signs of renal impairment)
Round to nearest 20mg for ease of administration
CrCl known to be under <10ml/min discuss with microbiology during working hours for gentamicin dosing/or alternative antibiotic recommendation.
If patient is obese ie. 20% over ideal body weight - use adjusted body weight

If renal failure
Co-amoxiclav IV 1.2g q8h or 625mg q8h PO if discharge

Continue 24hours after closure of wound