pneumoniae Clindamycin c Special cases Sickle cell disease Salmonella, S.. aureus Clindamycin and ceftriaxone Foot puncture wound Pseudomonas aeruginosa, S.. aureus Cefepime or piperacil
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Initial Antibiotic Therapy: Osteomyelitis a
Neonate <2 mo Staphylococcus aureus,
group B streptococcus, gram-negative bacilli
Vancomycin and ceftazidime
>2 mo–5 yrs S aureus, group A
streptococcus,
Streptococcus pneumoniae, Kingella kingae
Clindamycin b c
>5 yrs S aureus, group A
streptococcus, S.
pneumoniae
Clindamycin c
Special cases
Sickle cell disease Salmonella, S aureus Clindamycin and
ceftriaxone Foot puncture
wound
Pseudomonas aeruginosa, S.
aureus
Cefepime or piperacillin/tazobactam
Certain groups are at risk for particular organisms Patients with sickle cell disease have a high incidence of osteomyelitis caused by salmonella
Pseudomonas aeruginosa is a common organism found in osteomyelitis of the
foot, often resulting from a nail penetrating a sneaker
Clinical Indications for Discharge or Admission
Initial therapy for osteomyelitis includes hospital admission with intravenous antibiotics and pain control Empiric antibiotic therapy is based on the predominant organisms in each age group, local sensitivity patterns, the mechanism of infection, and Gram stain results Clindamycin is the treatment of choice for osteomyelitis outside of the neonatal age range when MRSA is suspected Vancomycin may be indicated for empiric treatment when the incidence of clindamycin resistance in the community is high or the patient is