Infection

Prosthetic joint infection

Antibiotic Therapy (before prescribing, carefully read the Notes / Comments section below)

Vancomycin IV (dosing info here)

and

Gentamicin IV (dosing info here)

Duration
IV minimum 2 weeks, total duration (IV and oral) 4-6 weeks dependent on surgical plan
Notes / Comments

If possible, obtain blood cultures, joint aspirates and, where possible, bone biopsies before starting treatment. 

A cell count and gram stain can only be performed on a joint aspirate sent in a sterile universal container.

Gentamicin must not be administered to patients with myasthenia gravis as it can precipitate a myasthenic crisis.

Review gentamicin therapy at 48-72 hours as per 'Review of Gentamicin after 48-72 Hours' guidance.

Patients with acute or chronic impairment of renal function and an eGFR <20ml/min and those with decompensated alcoholic liver disease are at increased risk of adverse events with gentamicin. IV temocillin (see here for dosing guidance) is a beta-lactam antimicrobial with a comparable breadth of gram negative cover which can replace gentamicin in these patient populations, provided they do not have a history of penicillin allergy.

 

 

Guideline reviewed September 2023
Page updated August 2026



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