1st Line for septic arthritis

[teehees]

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so kaplan, MTB and uptodate are all diffferent!

note there is nothing about age or sexual history being a consideration on uptodate and also it says to wait for a gram stain result before initiating treatment??

 

[recycledpaper]

First line in terms of treatment? Or do you mean first step?

And what your resources saying?

 

[teehees]

First line in treatment.

Uptodate doesnt give any empirical advice without gram stain.

Kaplan says according to age, or <40 years old use ceftriaxone for older patients use nafcillin or vanc

MTB says use ceftriaxone AND vancomycin

 

[recycledpaper]

I would look for any signs of a systemic response (are they septic? bacteremia?) because in those situations, I think it's reasonable to begin empiric treatment depending on most likely organism (like what Kaplan does). But, if it's super serious to the point where the pt is actually septic and hypotensive, broad spectrum abx makes the most sense because you'd rather kill everything than have to worry about resistance. Then once gram stain comes back, you can adjust accordingly.

I assume they're suggesting Rocephin for a young person d/t high prevalence of gonorrhea, and older patients MRSA?

 

[FutureInternist]

UTD is not for the boards so don't use it at this level

Go with the review books, and then later on just look it up

Once you get past the exams there is not that much (comparitively) that you have to remember since the info is so readily available in such easy formats