Pediatric Guidelines: Bone and Joint Infections - Septic Arthritis

Condition Major Pathogens First Choice Therapy Alternative Therapy Comments
Septic arthritis in child > 3 months old without medical comorbidities or penetrating trauma

Staphylococcus aureus

Group A streptococcus

Kingella kingae in children < 3 years

Incomplete immunization:   Haemophilus influenzae     Streptococcus pneumoniae

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


ID and Orthopedic Surgery consults recommended

Joint aspirate should be performed before antibiotics unless patient is clinically unstable or has known bacteremia

Consider adjunctive anti-inflammatory therapy prior to or concurrent with initial antibiotic dose - consult ID early for guidance on choice of steroid vs. NSAID

Ill-appearing or known positive blood culture (while awaiting final ID and susceptibility): 


Age 3mo-<12yo:17.5mg/kg/dose IV q6h (initial max 1g/dose)

Age >=12 yo: 15mg/kg/dose IV q6h (initial max 1g/dose)


Ceftriaxone 50mg/kg/dose IV q24h (max 2g/dose)

Bone or joint infection in patient with significant medical comorbidities, age 0-3 months, incomplete immunization, penetrating trauma, contiguous infection or other modifying factors Variable based on risk factors Consult ID for guidance before initiating empiric therapy   ID and Orthopedic Surgery consults recommended
These are guidelines only and not intended to replace clinical judgment. Modification of therapy may be indicated based on patient comorbidities, previous antibiotic therapy or infection history. Doses provided are usual doses but may require modification based on patient age or comorbid conditions. Refer to Pediatric Antimicrobial Dosing Guideline for further guidance on dosing in children, and Neonatal Dosing Guideline for infants < 1 month of age. Consult a pediatric pharmacist for individualized renal or hepatic dose adjustment. For additional guidance, please contact Pediatric Infectious Diseases (ID) or the Pediatric Antimicrobial Stewardship Program (ASP).