Osteomyelitis

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

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-susceptible streptococci and enterococci	penicillin VK 500 mg PO bid to tid
Cutibacterium acnes	amoxicillin 500 mg PO bid to tid
Cutibacterium acnes	penicillin VK 500 mg PO bid to tid

^ 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.