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Infection

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
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:
Ciprofloxacin 750mg PO q12h  (+/- rifampin 600mg PO qd) OR
Levofloxacin 750 mg PO qd (+/- rifampin 600mg PO qd for S. aureus if present) OR
Augmentin 500mg three times daily.
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).

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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.
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