Osteomyelitis: Difference between revisions

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**For example, [[vancomycin]] plus [[ceftriaxone]]
  
**For example, [[vancomycin]] plus [[ceftriaxone]]
   
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=== Parenteral Antimicrobials ===
 +
===Parenteral Antimicrobials===
 
{| class="wikitable"
  
{| class="wikitable"
 
!Organism
  
!Organism
 
!Antimicrobial Options
  
!Antimicrobial Options
 
|-
  
|-
  +
| rowspan="5" |[[MSSA]]
⚫
|
  
  +
|[[nafcillin]] 2 g IV q4h
⚫
|
  
 
|-
  
|-
  +
|[[oxacillin]] 2 g IV q4h
⚫
|
  
⚫
|
  
 
|-
  
|-
  +
|[[cefazolin]] 2 g IV q8h
⚫
|
  
−
|
 +
|-
  +
|[[flucloxacillin]] 2 g IV q6h
  ⚫
|-
  +
|[[ceftriaxone]] 2 g IV q24h
  ⚫
|-
  +
| rowspan="3" |[[MRSA]]
  +
|[[vancomycin]] 20 mg/kg load followed by 15-20 mg IV q8-12h
  ⚫
|-
  +
|[[daptomycin]] 6 to 10 mg/kg IV daily
  ⚫
|-
  +
|[[teicoplanin]] 12 mg/kg IV q12h for 3 to 5 doses followed by q24h
  ⚫
|-
  +
| rowspan="2" |Adjunctive staphylococcal agent
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|[[rifampin]] 300 to 450 mg PO bid
  +
|-
  +
|[[fusidic acid]] 500 mg PO tid
  +
|-
  +
| rowspan="7" |[[Gram-negative bacteria]]
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|[[ciprofloxacin]] 750 mg PO big to 400 mg IV q12h
  +
|-
  +
|[[levofloxacin]] 750 mg PO/IV daily
  +
|-
  +
|[[ceftriaxone]] 2 g IV q24h
  +
|-
  +
|[[ceftazidime]] 2 g IV q8h
  +
|-
  +
|[[cefepime]] 2 g IV q8-12h
  +
|-
  +
|[[ertapenem]] 1 g IV q24h
  +
|-
  +
|[[meropenem]] 1 g IV q8h
  +
|-
  +
|[[Pseudomonas aeruginosa]]
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|[[ciprofloxacin]] 400 mg IV q8h
  +
|-
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| rowspan="8" |[[Enterococcus species]]
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|[[ampicillin]] 12 g continuous IV q24h
  +
|-
  +
|[[ampicillin]] 2 g IV q4h
  +
|-
  +
|[[penicillin G]] 20 to 24 million units continuous IV q24h
  +
|-
  +
|[[penicillin G]] 3-4 million units IV q4h
  +
|-
  +
|[[vancomycin]] 20 mg/kg IV load followed by 15 mg/kg IV q12h (max 2 g per dose)
  +
|-
  +
|[[daptomycin]] 6 to 10 mg/kg IV daily
  +
|-
  +
|[[teicoplanin]] 12 mg/kg IV q12h for 3 to 5 doses, followed by q24h
  +
|-
  +
|[[ampicillin]] as above, PLUS [[ceftriaxone]] 2 g IV q12-24h
  +
|-
  +
| rowspan="6" |penicillin-susceptible [[streptococci]]
  +
|[[ampicillin]] 12 g continuous IV q24h
  +
|-
  +
|[[ampicillin]] 2 g IV q4h
  +
|-
  +
|[[penicillin G]] 20 to 24 million units continuous IV q24h
  +
|-
  +
|[[penicillin G]] 3-4 million units IV q4h
  +
|-
  +
|[[ceftriaxone]] 2 g IV q24h
  +
|-
  +
|[[vancomycin]] 20 mg/kg IV load followed by 15 mg/kg IV q12h (max 2 g per dose)
  +
|-
  +
| rowspan="3" |[[Cutibacterium acnes]]
  +
|[[penicillin G]] 20 to 24 million units continuous IV q24h
  +
|-
  +
|[[penicillin G]] 3-4 million units IV q4h
  +
|-
  +
|[[ceftriaxone]] 2 g IV q24h
 
|}
  
|}
   
−
=== Oral Antimicrobials ===
 +
===Oral Antimicrobials===
 
{| class="wikitable"
  
{| class="wikitable"
 
!Organism
  
!Organism

Revision as of 09:13, 14 January 2021

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

Parenteral Antimicrobials

Organism Antimicrobial Options
MSSA nafcillin 2 g IV q4h
oxacillin 2 g IV q4h
cefazolin 2 g IV q8h
flucloxacillin 2 g IV q6h
ceftriaxone 2 g IV q24h
MRSA vancomycin 20 mg/kg load followed by 15-20 mg IV q8-12h
daptomycin 6 to 10 mg/kg IV daily
teicoplanin 12 mg/kg IV q12h for 3 to 5 doses followed by q24h
Adjunctive staphylococcal agent rifampin 300 to 450 mg PO bid
fusidic acid 500 mg PO tid
Gram-negative bacteria ciprofloxacin 750 mg PO big to 400 mg IV q12h
levofloxacin 750 mg PO/IV daily
ceftriaxone 2 g IV q24h
ceftazidime 2 g IV q8h
cefepime 2 g IV q8-12h
ertapenem 1 g IV q24h
meropenem 1 g IV q8h
Pseudomonas aeruginosa ciprofloxacin 400 mg IV q8h
Enterococcus species ampicillin 12 g continuous IV q24h
ampicillin 2 g IV q4h
penicillin G 20 to 24 million units continuous IV q24h
penicillin G 3-4 million units IV q4h
vancomycin 20 mg/kg IV load followed by 15 mg/kg IV q12h (max 2 g per dose)
daptomycin 6 to 10 mg/kg IV daily
teicoplanin 12 mg/kg IV q12h for 3 to 5 doses, followed by q24h
ampicillin as above, PLUS ceftriaxone 2 g IV q12-24h
penicillin-susceptible streptococci ampicillin 12 g continuous IV q24h
ampicillin 2 g IV q4h
penicillin G 20 to 24 million units continuous IV q24h
penicillin G 3-4 million units IV q4h
ceftriaxone 2 g IV q24h
vancomycin 20 mg/kg IV load followed by 15 mg/kg IV q12h (max 2 g per dose)
Cutibacterium acnes penicillin G 20 to 24 million units continuous IV q24h
penicillin G 3-4 million units IV q4h
ceftriaxone 2 g IV q24h

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

  1. ^  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.

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