Management of a child with suspected acute septic arthritis

Acute septic arthritis of childhood is a potentially devastating disease that causes permanent disability and can result in death. Traditional treatment consists of a prolonged course of intravenous antibiotics combined with aggressive surgery. However, this approach is challenged by trials showing satisfactory outcomes with shorter treatment and less invasive surgery. Diagnostic arthrocentesis alone and an antibiotic for a fortnight, including initial intravenous administration for 2-4 days, suffice in most non-neonatal cases. A good penetrating agent, such as clindamycin or a first-generation cephalosporin, exceptionally high doses, and administration four times a day are probably key factors. If the symptoms and signs subside within a few days, and the serum C-reactive protein level drops below 20 mg/l, the antibiotic can usually be safely discontinued. Methicillin-resistant Staphylococcus aureus is a concern, but fortunately, most strains have retained susceptibility to clindamycin. The above guidance is not applicable to neonates and immunocompromised patients who may require a different approach.