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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.
 AlterativelyVancomycin 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 + Metronidazole 500mg IVPB q6-8 hours).

 

Osteomyelitis

 


 


 

 

Antimicrobial Series
References

American Hospital Formulary Service.  Drug Information. Bethesda, MD: ASHP, 1997.
Baden LR, Eisenstein BI.Impact of Antibiotic Resistance on the Treatment of Gram-negative Sepsis.
Curr Infect Dis Rep. 2000 Oct;2(5):409-416.
Bartlett JG et al. Community-acquired pneumonia in adults: guidelines for management. Guidelines from the Infectious Diseases Society of America. Clin Infect Dis. 1998;26:811-38.
Bartlett JG: Empirical therapy of community-acquired pneumonia: macrolides are not ideal choices. Semin Respir Infect 1997 Dec; 12(4): 329-33
Bartlett JG.1998 Pocket Book of Infectious Disease Therapy., Ninth Edition. Baltimore,MD: Williams&Wikins,1998.
Bernstein JM: Treatment of community-acquired pneumonia--IDSA guidelines. Infectious Diseases Society of America. Chest 1999 Mar; 115(3 Suppl): 9S-13S
Drug Information Handbook, 5th Ed. 1997, Lexi-Comp inc. 
Ewig S et al. Pneumonia acquired in the community through drug-resistant Streptococcus pneumoniae. Am J Respir Crit Care Med. 1999;159:1835-42.
File TM Jr. Community-acquired pneumonia: recent guidelines for therapy. J Respir Dis. 1999;20:534-41.
Gilbert DN, Moellering RC, Sande MA. The Sanford Guide to Antimicrobial Therapy 2000. 30th ed. Hyde Park,VT: Antimicrobial Therapy, Inc.; 2000.
Gold HS, Moellering RC. Antimicrobial-drug resistance. N Engl J Med. 1996;335:1445-1453.
Gonzales R, Sande M: What will it take to stop physicians from prescribing antibiotics in acute bronchitis? Lancet 1995 Mar 18; 345(8951): 665-6
Hooton TM, Stamm WE. Diagnosis and treatment of uncomplicated urinary tract infection. Infect Dis Clin North Am 1997;11:551-581.
Lipsky BA, Berendt AR.Principles and practice of antibiotic therapy of diabetic foot infections.
Diabetes Metab Res Rev. 2000 Sep-Oct;16 Suppl 1:S42-6.
Mufson MA.Pneumococcal Pneumonia.
Curr Infect Dis Rep. 1999 Apr;1(1):57-64.
Reese RE, Betts RF: A Practical Approach to Infectious Diseases. 4th ed. Boston: Little, Brown, and Company; 1996: 251
Stefani SD, Cadore LP, Villaroel RU, Azevedo S, Machado AL. Antibiotic Selection in the Treatment of Febrile Neutropenia: Current Approach and New Directions.
Braz J Infect Dis. 1998 Jun;2(3):109-117.
Stamm WE, Hooton TM. Management of urinary tract infections in adults. N Engl J Med 1993;329:1328-1334.

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