Infectious Arthritis Follow Up

Monitor the patient for improvement of clinical signs and symptoms. The levels of ESR and CRP may be used to evaluate response to treatment. Serial analysis of the synovial fluid should show a decreasing WBC count and should revert to the sterile state with treatment. Continue the empiric treatment if the patient is improving and cultures are negative. If a patient does not improve with appropriate treatment, consider revision of antibiotic therapy; open drainage of the joint, biopsy and repeat culture, washout or debridement may be required; repeat tests to uncover a possible non-infectious cause of arthritis; and consider specialist referral. Specialist referral should be considered in patients with features of sepsis for possible drainage and parenteral antibiotic therapy. Outpatient parenteral antibiotic therapy (OPAT) may be considered in patients in whom it is not feasible to complete treatment with oral antibiotics. OPAT program should have a complete and qualified health care team, efficient means of communication, guidelines for follow-up, testing and other interventions, written policies and procedures, and outcomes monitoring. A candidate for inclusion in an OPAT program should be willing to participate in the program and should have a home environment that is sufficient to support care.