Osteomyelitis
General recommendation is 4-6 weeks IV therapy |
Possible therapeutic alternatives |
| Hematogenous (Adult) (Associated conditions: trauma, bacteremia)
"Contiguous Focus" |
Common pathogens |
Vancomycin 1 gram ivpb q12h (patient-specific dosing required - target trough 15-20 mcg/ml)
PLUS
Ceftazidime 2 grams IV every 8 hours or Cefepime 2 grams q 12h |
Methicillin-sensitive Staph aureus (MSSA)
|
| Nafcillin or Oxacillin 2 grams IVPB q4h or |
| Cefazolin 2 grams IVPB q8h or |
MRSA
|
Vancomycin 1 gram ivpb q12h (patient-specific dosing required - target trough 15-20 mcg/ml)
+/-
rifampin
OR
Linezolid 600 mg orally or IV q 12h |
| Gram negative rods are suspected: |
| 3rd generation cephalosporin such as: [Ceftriaxone 2g IV qd or Cefotaxime 2g IV q6-8h or Ceftazidime 2g IV q8h or Cefepime 2g IV q12h]
PLUS
Vancomycin 1 gram ivpb q12h (patient-specific dosing required - target trough 15-20 mcg/ml) |
Ciprofloxacin 400mg IV q12h then may switch to Cipro 750mg PO q12h
OR
Levofloxacin 750mg IV (then PO) qd |
|
| IVDA; hemodialysis patient |
Common pathogens |
Vancomycin 1 gram ivpb q12h (patient-specific dosing required - target trough 15-20 mcg/ml)
+
Ciprofloxacin 400mg IVPB q12h. |
MSSA:
Nafcillin 2 grams IVPB q4h plus Ciprofloxacin 400mg IVPB q12h. |
|
| Prosthetic joint |
Common pathogens |
Vancomycin 1 gram ivpb q12h (patient-specific dosing required - target trough 15-20 mcg/ml)
+
Ciprofloxacin 400mg IVPB q12h or 750mg po q12h. (continue until cultures are available). |
| Alternatively: Ciprofloxacin 750mg po q12h + Rifampin 900mg po x 1 dose. |
|
| Post nail puncture of foot. |
Common pathogens |
|
| Osteomyelitis due to vascular insufficiency. Associated conditions include diabetes, neuropathy, vascular disease |
Common pathogens |
|
