Chapter 120. Osteomyelitis (Part 5) docx

Osteomyelitis Part 5 Table 120-2 Selection of Antibiotics for Treatment of Acute Osteomyelitis Staphylococcus aureus Penicillin- Nafcillin or oxacillin, 2 g Cefazolin, 1 g IV...

Chapter 120 Osteomyelitis

(Part 5)

Table 120-2 Selection of Antibiotics for Treatment of Acute Osteomyelitis

Staphylococcus

aureus

Penicillin- Nafcillin or oxacillin, 2 g Cefazolin, 1 g IV

resistant,

methicillin-sensitive (MSSA)

q24h; clindamycin, 900

mg IV q8hc

Penicillin-sensitive

Penicillin, 3–4 million U

IV q4h

Cefazolin, ceftriaxone, clindamycin (as above)

Methicillin-resistant (MRSA)

Vancomycin, 15 mg/kg

IV q12h; rifampin, 300 mg PO q12h (see text)

Clindamycinc (as above); linezolid, 600

mg IV or PO q12hd; daptomycin, 4–6 mg/kg

IV q24hd

Streptococci

(including S milleri,

b-hemolytic

streptococci)

Penicillin (as above) Cefazolin,

ceftriaxone, clindamycin (as above)

Gram-negative

aerobic bacilli

Escherichia

coli, other "sensitive"

species

Ampicillin, 2 g IV q4h;

cefazolin, 1 g IV q8h

Ceftriaxone, 1 g

IV q24h; parenteral or oral fluoroquinolone (e.g., ciprofloxacin, 400

mg IV or 750 mg PO q12h)e

Pseudomonas

aeruginosa

Extended-spectrum b-lactam agent (e.g., piperacillin, 3–4 g IV q4–6h; or ceftazidime,

2 g IV q12h) plus tobramycin,

5–7 mg/kg q24hf

May substitute parenteral or oral fluoroquinolone for b-lactam agents (if patient

is allergic) or for tobramycin (in relation

to nephrotoxicity)

spp., other "resistant"

species

fluoroquinolone IV or POe (as above)

Mixed infections

possibly involving

anaerobic bacteria

Ampicillin/sulbactam,

piperacillin/tazobactam, 3.375 g

IV q6h

Carbapenem

combination of a fluoroquinolone plus clindamycin (as above)

or metronidazole, 500

mg PO tid

a

Duration of treatment is discussed in the text

b

Cephalosporins may be used for the treatment of patients allergic to penicillin whose reaction did not consist of anaphylaxis or urticaria (immediate-type hypersensitivity)

c

Because of the possibility of inducible resistance, clindamycin must be used with caution for the treatment of strains resistant to erythromycin Consult

clinical microbiology laboratory

d

Experience is limited; there are anecdotal reports of efficacy

e

Oral fluoroquinolones must not be coadministered with divalent cations (calcium, magnesium, iron, aluminum), which block the drugs' absorption

f

Tobramycin levels and renal function must be monitored closely to minimize the risks of nephro- and ototoxicity