Osteomyelitis: antibiotic therapy recommendations

Infection

Osteomyelitis
General recommendation is 4-6 weeks IV therapy

Possible therapeutic alternatives

Hematogenous (Adult) (Associated conditions: trauma, bacteremia)

Common pathogens

Nafcillin or Oxacillin 2 grams IVPB q4h or

Cefazolin 2 grams IVPB q8h or

Vancomycin 1 gram IVPB q12h +/- rifampin

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 Nafcillin or Vancomycin.

Ciprofloxacin 400mg IV q12h then may switch to Cipro 750mg PO q12h or give Levofloxacin 500mg IV (then PO) qd

Ciprofloxacin 750mg orally q12h or 400mg IVPB q12h plus rifampin 600mg po qd.

IVDA; hemodialysis patient

Common pathogens

Nafcillin 2 grams IVPB q4h plus Ciprofloxacin 400mg IVPB q12h.

Alteratively: Vancomycin 1 gram IVPB q12h + Ciprofloxacin 400mg IVPB q12h.

Prosthetic joint

Common pathogens

Vanco 1 gram IVPB q12h + 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

Ceftazidime 1-2 grams IVPB q8h or Cefepime 2 grams IVPB q12h or Ciprofloxacin 750mg po q12h.

Osteomyelitis due to vascular insufficiency. Associated conditions include diabetes, neuropathy, vascular disease

Common pathogens

Mild disease:

Augmentin 500mg three times daily.

Ciprofloxacin 750mg PO q12h (+/- rifampin 600mg PO qd)

Levofloxacin 500mg PO qd (+ rifampin 600mg PO qd for S. aureus if present)

Severe disease:

Piperacillin-tazobactam 3.375 grams IVPB q4-6h or

Ticarcillin-clavulanic acid 3.1 grams IVPB q4-6h or

Ampicillin-sulbactam 1.5 to 3 grams IVPB q6h or

(Ciprofloxacin 400mg IVPB q12h + Clindamycin 600 to 900mg IVPB q6-8 hours) or

(Cefepime 1-2 grams IVPB q12h + Metronidazole 500mg IVPB q6-8 hours).

Images

Osteomyelitis

References - Infectious Disease Section

Infectious Disease References

Disclaimer

The authors make no claims of the accuracy of the information contained herein; and these suggested doses are not a substitute for clinical judgement. Neither GlobalRPh Inc. nor any other party involved in the preparation of this program shall be liable for any special, consequential, or exemplary damages resulting in whole or part from any user's use of or reliance upon this material.
PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. Read the disclaimer