Osteomyelitis
From IDWiki
Management
- No clinically meaningful differences in bone penetration between classes of antibiotics exist1
- Bioavailability likely still important
- Empiric antimicrobials should generally cover MRSA, susceptible Gram-positives, and common Gram-negatives
- For example, vancomycin plus ceftriaxone
Parenteral Antimicrobials
| Organism | Antimicrobial Options |
|---|---|
Oral Antimicrobials
| Organism | Antibiotic Options |
|---|---|
| MSSA | cefadroxil 500 to 1000 mg PO bid |
| cephalexin 500 mg PO tid to qid, or 1000 mg PO bid to tid | |
| dicloxacillin 500 mg PO tid to qid | |
| flucloxaxillin 500 mg PO tid to qid | |
| MRSA | TMP-SMX DS 1 tablet PO bid |
| doxycycline 100 mg PO bid | |
| minocycline 100 mg PO bid | |
| clindamycin 600 mg PO tid | |
| Gram-negative bacteria | TMP-SMX DS 1 tablet PO bid |
| ciprofloxacin 500 mg PO bid | |
| levofloxacin 500 mg PO daily | |
| penicillin-susceptible streptococci and enterococci | amoxicillin 500 mg PO bid to tid |
| penicillin VK 500 mg PO bid to tid | |
| Cutibacterium acnes | amoxicillin 500 mg PO bid to tid |
| penicillin VK 500 mg PO bid to tid |
References
- ^ Elysia A. Masters, Benjamin F. Ricciardi, Karen L. de Mesy Bentley, T. Fintan Moriarty, Edward M. Schwarz, Gowrishankar Muthukrishnan. Skeletal infections: microbial pathogenesis, immunity and clinical management. Nature Reviews Microbiology. 2022. doi:10.1038/s41579-022-00686-0.
- ^ Cornelia B. Landersdorfer, Jürgen B. Bulitta, Martina Kinzig, Ulrike Holzgrabe, Fritz Sörgel. Penetration of Antibacterials into Bone. Clinical Pharmacokinetics. 2009;48(2):89-124. doi:10.2165/00003088-200948020-00002.
- ^ Ho-Kwong Li, Ines Rombach, Rhea Zambellas, A. Sarah Walker, Martin A. McNally, Bridget L. Atkins, Benjamin A. Lipsky, Harriet C. Hughes, Deepa Bose, Michelle Kümin, Claire Scarborough, Philippa C. Matthews, Andrew J. Brent, Jose Lomas, Roger Gundle, Mark Rogers, Adrian Taylor, Brian Angus, Ivor Byren, Anthony R. Berendt, Simon Warren, Fiona E. Fitzgerald, Damien J.F. Mack, Susan Hopkins, Jonathan Folb, Helen E. Reynolds, Elinor Moore, Jocelyn Marshall, Neil Jenkins, Christopher E. Moran, Andrew F. Woodhouse, Samantha Stafford, R. Andrew Seaton, Claire Vallance, Carolyn J. Hemsley, Karen Bisnauthsing, Jonathan A.T. Sandoe, Ila Aggarwal, Simon C. Ellis, Deborah J. Bunn, Rebecca K. Sutherland, Gavin Barlow, Cushla Cooper, Claudia Geue, Nicola McMeekin, Andrew H. Briggs, Parham Sendi, Elham Khatamzas, Tri Wangrangsimakul, T.H. Nicholas Wong, Lucinda K. Barrett, Abtin Alvand, C. Fraser Old, Jennifer Bostock, John Paul, Graham Cooke, Guy E. Thwaites, Philip Bejon, Matthew Scarborough. Oral versus Intravenous Antibiotics for Bone and Joint Infection. New England Journal of Medicine. 2019;380(5):425-436. doi:10.1056/nejmoa1710926.
