Staphylococcal Bone and Joint Infections : Oral Antibiotics

• The most common organisms causing bone and joint infections are staphylococci, including Staphylococcus aureus and coagulase-negative staphylococci.
• The type of infection, the presence of an implant and the treatment strategy should be considered when selecting antibiotics to treat bone and joint infections.
• Intravenous therapy is administered for the first 2–4 weeks, followed by longterm oral therapy to complete the treatment.
• Optimum duration of antibiotic treatment for bone and joint infections remains unknown because this has never been studied in prospective randomized studies. The suggested duration of oral antibiotic therapy:

1)     Hip prostheses – 3months 

2)     Knee prostheses – 6 months 

3)     Fracture fixation  device that is retained – 3 months

4)     Fracture fixation  device that is removed – 6 weeks /long term

5)     Vertebral osteomyelitis the recommended –  4–6 weeks to 3 months

6)     Undrained abscesses or spinal implants - Prolonged antibiotic

7)     Arthritis - a 2–3 week 

Key Recommendations & Principle                            

• Ideally, the antibiotic used, particularly in implant-associated infections, should have bactericidal activity against surface-adhering, slow-growing and biofilm-producing staphylococci.
•  In general rifampicin/fluoroquinolone should be considered as the first-line combination regimen, especially for implant-associated infections since this combination has been the most extensively studied and its efficacy has been established.
• Initial therapy for treatment of S. aureus infection following one-stage replacement arthroplasty consists of four to six weeks of pathogen-specific intravenous therapy in combination with rifampin (300 to 450 mg orally twice daily). Subsequent therapy consists of three months of pathogen-specific oral therapy in combination with rifampin.
• When treatment fails or patient can’t tolerate first line antibiotics combinations of fluoroquinolones with other antibiotics such as fusidic acid, clindamycin, trimethoprim/sulfamethoxazole or a tetracycline may be considered.
• Finally, when combinations of antibiotics cannot be employed, monotherapy can be tried as a last resort with the use of fluoroquinolone, clindamycin, trimethoprim/sulfamethoxazole, pristinamycin or linezolid. 

References : 

1. Kim, B.-N., Kim, E. S., & Oh, M.-D. (n.d.). Oral antibiotic treatment of staphylococcal bone and joint infections in adults. http://doi.org/10.1093/jac/dkt374

 2. www.uptodate.com