ORT 3.2 Septic arthritis - Staphylococcus aureus (S. aureus)

Content version: U-106.2
Updated: 10/20/2025 - 15:10

Recommendations

≥ 18 years

Indications: Without bacteraemia
	Dosage	Remarks
	flucloxacillin IV 6 g/24 h continuous	Loading dose 1 gram flucloxacillin bolus, then continuous infusion (If continuous infusion is not possible, then flucloxacillin 1 g six times daily)

≥ 18 years

Indications: With bacteraemia
	Dosage	Remarks
	flucloxacillin IV 12 g/24 h continuous	Loading dose 2 gram flucloxacillin bolus, then continuous infusion. (If continuous infusion is not possible, then flucloxacillin 2 g six times daily)

≥ 18 years

Indications: In case of allergy to penicillins*
	Dosage	Remarks
	cefazolin IV 2000 mg three times daily	Non-severe penicillin allergy
	clindamycin oral 600 mg three times daily	Severe beta-lactam allergy (without bacteraemia)

Comments

*See protocol Policy for allergy to antibiotics | Radboud UMC

Without bacteraemia:

Treat intravenously for at least 1 week
Total antibiotic duration for an uncomplicated course: 4 weeks
If susceptibility is confirmed and there is a good clinical response, switch to oral therapy with clindamycin 600 mg three times daily. In clindamycin resistance, co-trimoxazole 960 mg twice daily or flucloxacillin 1000 mg four times daily orally is an alternative

With bacteraemia:

Treat intravenously for at least two weeks and longer depending on other metastatic foci (for example, endocarditis).
Request a bedside consult with an infectious diseases specialist.