When synovial fluid Gram stain reveals gram-positive cocci, this finding identifies the most prevalent bacterial pattern in septic arthritis — predominantly Staphylococcus and Streptococcus species. Antibiotic selection is guided by this result before culture data are available.
Initial treatment is directed at gram-positive cocci and involves a combination antibiotic regimen. An alternative oral-based approach is also recognised, including the option of converting from intravenous to oral therapy. Treatment duration is determined by the joint involved and clinical response.
Antibiotic treatment should be based on results of a synovial fluid Gram stain or suspicion of a pathogen from the clinical scenario.
Antibiotics should initially cover gram-positive cocci because they are most common (in particular Staphylococcus and Streptococcus species).
Clindamycin-based therapy appears to be a safe, effective alternative to the traditional regimen of vancomycin or daptomycin (Cubicin) plus a cephalosporin, carbapenem, or fluoroquinolone, especially when it is combined with fluoroquinolones.
Clindamycin-based therapy also allows direct conversion from intravenous to oral therapy.
Optimal duration of treatment for nongonococcal septic arthritis is uncertain but is at least two weeks for small joints; at least six weeks is more commonly prescribed for all joints.
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