TABLE 2.

Initial choice of antibiotics for therapy of infectious arthritis (adult doses)

OrganismAntibiotics of first choiceAlternative antibiotics
Methicillin resistant
    Staphylococcus aureusVancomycin 1 g every 12 h orSXTa or minocycline ± rifampin
linezolid 600 mg every 12 h
    Coagulase-negative Staphylococcus spp.Vancomycin 1 g every 12 h orSXT or minocycline ± rifampin, clindamycinb
linezolid 600 mg every 12 h
Methicillin sensitive
    Staphylococcus aureusNafcillin 2 g every 6 h orCefazolin, vancomycin
clindamycin 900 mg every 8 h
    Coagulase-negative Staphylococcus spp.Nafcillin 2 g every 6 h orCefazolin, vancomycin
clindamycin 900 mg every 8 h
    Group A streptococcus, S. pyogenesPenicillin G 2 million every 4 h orClindamycin, cefazolin
ampicillin 2 g every 6 h
    Group B streptococcus, S. agalactiaePenicillin G 2 million every 4 h orClindamycin, cefazolin
ampicillin 2 g every 6 h
    Enterococcus spp.Ampicillin 2 g every 6 hc orAmpicillin-sulbactam, linezolid
vancomycin 1 g every 12 h
    Escherichia coliAmpicillin-sulbactam 3 g every 6 hCefazolin, levofloxacin, gentamicin, SXT
    Proteus mirabilisAmpicillin 2 g every 6 h orCefazolin, SXT, gentamicin
Levofloxacin 500 mg daily
    Proteus vulgaris, Proteus rettgeri,     Morganella morganiiCefotaxime 2 g every 6 h, imipenem 500 mg every 6 h, or levofloxacin 500 mg dailyMezlocillin, gentamicin, or ticarcillin-clavulanate
    Serratia marcescensCefotaxime 2 g every 6 hLevofloxacin, gentamicin, imipenem
    Pseudomonas aeruginosaCefepimed 2 gm every 12 h orTicarcillin-clavulanate, tobramycin, amikacin, ciprofloxacine
Piperacillind 3 gm every 6 h or
Imipenem 500 every 6 h
    Neisseria gonorrheaCeftriaxone 2 g daily orLevofloxacin, ampicillin
Cefotaxime 1 g every 8 h
    Bacteroides fragilis groupClindamycin 900 mg every 8 h orAmpicillin-sulbactam, ticarcillin-clavulanic acid
metronidazole 500 mg every 8 h
  • a SXT, sulfamethoxazole-trimethoprim.

  • b If sensitive to clindamycin.

  • c In a serious Enterococcus infection, ampicillin plus an aminoglycoside is used.

  • d In a serious infection, those drugs should be used with an aminoglycoside.

  • e Increasing resistance of the quinolones including ciprofloxacin.