Septic Arthritis

Septic arthritis in child > 3 months old
without medical comorbidities or other exception criteria defined below

Kocher Criteria for Septic Hip 

Staphylococcus aureus

Group A streptococcus

Kingella kingae in children < 3 years

------------------------

Lyme arthritis is a distinct diagnosis separate from septic arthritis and should be considered in the differential diagnosis

Clinically stable:

Cefazolin 50 mg/kg/dose (max 2000 mg/dose) IV q8h

------------------------

Severely ill (hemodynamic instability, multiple sites involved, or known positive blood culture for gram-positive organism):

Cefazolin 50 mg/kg/dose (max 2000 mg/dose) IV q8h

AND

Vancomycin
(follow link for dosing & monitoring)

Penicillin or cephalosporin allergy with higher risk for allergic reaction OR clinically stable with prior MRSA

Please confirm clindamycin susceptibility if prior cultures are available 

Clindamycin 13 mg/kg/dose (max 900 mg/dose) IV q8h

ID and Orthopedic Surgery consults recommended

Surgical evaluation is urgent for suspected septic arthritis, particularly hip, knee, or shoulder

Send ESR, CRP, and blood culture at initial evaluation