Oral antimicrobial agents for completing treatment of septic arthritis due to methicillin-resistant Staphylococcus aureus (MRSA) in adults*

DS: double strength (ie, 160 mg trimethoprim with 800 mg sulfamethoxazole per tablet).
* Following joint drainage, the typical duration of antibiotic therapy for treatment of septic arthritis is three to four weeks; we typically administer parenteral antibiotics for at least 14 days followed by oral therapy for an additional 14 days. If linezolid is used as initial therapy, it may be administered orally for the entire duration given its high oral bioavailability.
¶ The mechanism of action for tedizolid is comparable with that of linezolid; however, thus far there are no data/experience regarding use of tedizolid for treatment of septic arthritis.
Δ Patients who cannot take rifampin because of drug resistance, allergy, toxicity, intolerance, or drug-drug interactions should remain on intravenous antistaphylococcal therapy for 4 to 6 weeks (before transitioning to antibiotic suppression with an oral regimen, if warranted).
◊ We favor administration of rifampin 450 orally twice daily; the dose may be reduced to 300 mg orally twice daily in the setting of nausea.
§ Not available in the United States. Fusidic acid should not be used alone; it must be combined with a second active agent to reduce the likelihood of selection for drug resistance. When rifampin is combined with fusidic acid, fusidic levels may be reduced.