Septic arthritis
Aspirate the hot joint before antibiotics, read the synovial fluid properly, choose flucloxacillin, cefazolin or vancomycin by MRSA risk, drain the joint, and think gonococcus in the young.
Tier 1Condition
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- A hot, swollen, painful joint is septic arthritis until the aspirate says otherwise. Cartilage can be destroyed within days, and mortality is around 10%, higher with polyarticular disease.
- Aspirate before antibiotics, unless the patient is septic and the aspirate would be delayed. Take blood cultures either way.
- Staphylococcus aureus causes most native joint infection. Choose cover by MRSA risk, which is high in northern Australia.
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Sources
- Therapeutic Guidelines: Antibiotic. Bone and joint infectionsAU/NZTherapeutic Guidelines Limited (eTG complete), 2025 to 2026 staged update; guideline-wide changes March 2025 (topic version not verified)
- Australian STI Management Guidelines for Use in Primary Care (gonorrhoea, disseminated gonococcal infection)AU/NZAustralasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM), online, accessed November 2026
- Guideline for management of septic arthritis in native joints (SANJO)European Bone and Joint Infection Society (Journal of Bone and Joint Infection 2023;8:29-37), 2023
- BSR and BHPR, BOA, RCGP and BSAC guidelines for management of the hot swollen joint in adultsBritish Society for Rheumatology (Rheumatology 2006); update scope published 2025 (Rheumatology Advances in Practice, doi 10.1093/rap/rkaf058), 2006, update in development
- Gjika E et al. Two weeks versus four weeks of antibiotic therapy after surgical drainage for native joint bacterial arthritis: a prospective, randomised, non-inferiority trial. Ann Rheum Dis 2019;78:1114-21Annals of the Rheumatic Diseases, 2019
- Li HK et al. Oral versus intravenous antibiotics for bone and joint infection (OVIVA). N Engl J Med 2019;380:425-36New England Journal of Medicine, 2019
- Last updated
- 14 November 2026
What changed
- 14 November 2026 Personal emails, About story and Australian-style copy