| 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 |