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Osteomyelitis Microorganisms
- • Most likely pathogen- S. aureus
- • Foreign materials/implants- Staphylococci other than S. aureus
- • Contamination- Pseudomonas
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Osteomyelitis Tx Duration
- • Acute- minimum 4‐6 wks
- • Chronic- minimum 6‐12 wks
- • 2‐6 wks of IV with potential transition to PO to complete
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Empiric Gram + Oseteomyelitis Tx (Preferred)
Vancomycin IV ± Rifampin IV/PO
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Empiric Gram + Oseteomyelitis Tx (Alternative)
- • Linezolid 600 mg IV/PO Q12H
- • Daptomycin 6 mg/kg IV once daily
- • ± Rifampin IV/PO
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MSSA Osteomyelitis Tx
- • Nafcillin or oxacillin 2g IV q4h
- • Cefazolin 2g IV q8h or ceftriaxone 2g IV q24h
- • ± Rifampin IV/PO 600 mg IV q6h or 900mg IV q8h
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MRSA Osteomyelitis Tx
- • Continuation of empiric vancomycin therapy
- • Linezolid 600 mg PO Q12H
- • ± Rifampin IV/PO 600 mg IV q6h or 900mg IV q8h
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Streptococci Osteomyelitis Tx
- • Penicillin G 2‐4 MU IV q4‐6h
- • Cefazolin 2g IV q8h or ceftriaxone 2g IV q24h
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Mixed Osteomyelitis Tx
- • Ampicillin/sulbactam 3g IV q6h (no Pseudomonal coverage)
- • Piperacillin/tazobactam 3.375g IV q4‐6h (likely Pseudomonas)
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Enterobacteriaceae (not P. aeruginosa) Osteomyelitis Tx
- • Ceftriaxone 2g IV q24h
- • Ertapenem 1g IV q24h
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P. aeruginosa Osteomyelitis Tx
- • Ciprofloxacin 400mg IV q8‐12h; 750mg PO q12h
- • Levofloxacin IV/PO 750 mg daily
- • Cefepime 2g IV q12h
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Staphylococci (especially MRSA) Osteomyelitis (Consolidative or Suppressive Oral Regimen)
- • TMP/SMX DS 2 tabs PO BID‐TID
- • Linezolid 600 mg PO q12h
- • Clindamycin 300‐450 mg PO QID + rifampin
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MSSA, Streptococci, GNB, Anaerobes Osteomyelitis (Consolidative or Suppressive Oral Regimen)
Amoxicillin/clavulanate 500 mg PO q8h
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Enterobacteriaceae Osteomyelitis (Consolidative or Suppressive Oral Regimen)
- • Ciprofloxacin 750 mg PO q12h
- • Levofloxacin 500‐750 mg PO q24h
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Anaerobes Osteomyelitis (Consolidative or Suppressive Oral Regimen)
Metronidazole 500 mg PO q6‐8h
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Septic Arthritis Microorganisms
- • Most common pathogen- S. aureus
- • Neonates & young children- Streptococcus
- • Older children & healthy adults- Staphylococcus
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Bacterial, Nongonococcal Septic Arthritis
- • Fever, chills, elevated WBCs
- • Monoarticular
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Gonococcal Septic Arthritis
- • N. gonorrhoeae
- • Triad: vesicular skin lesions, tenosynovitis, migratory arthritis or arthralgia
- • Polyarticular
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Empiric Septic Arthritis: Neonates and Children
- • Gram‐positive and ‐negative organisms
- – Infants (<1 mo): nafcillin or oxacillin PLUS cefotaxime
- – Children: nafcillin, oxacillin, or cefazolin
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Empiric Septic Arthritis Adults
- • Gram‐positive organisms
- • Add coverage for gram‐negative organisms if revealed on gram stain
- • Consider gonococcal septic arthritis
- → If risk for STDs, polyarticular
- → Drug of choice: ceftriaxone 1g IV/IM q24h
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Empiric Gram + Septic Arthritis
Vancomycin
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Empiric Gram - Septic Arthritis
- • Ceftriaxone
- • Cirpofloxacin/levofloxacin
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Septic Arthritis Duration of Tx
- • S. aureus: 4‐6 weeks
- • Streptococci: 2‐4 weeks
- • Gram negative bacteria: 4 weeks
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MSSA Septic Arthritis Tx
- • Nafcillin or oxacillin 2g IV q4h
- • Cefazolin 2g IV q8h
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MRSA Septic Arthritis Tx
Vancomycin IV (Troughs 15‐20 mcg/mL)
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Streptococci Septic Arthritis Tx
- • Penicillin G 12‐18 MU IV/day
- • Ampicillin 2g IV q4h
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S. pneumoniae Septic Arthritis Tx
- • Ceftriaxone 1‐2g IV q12‐24h
- • Cefotaxime 2g IV q8h
- • Vancomycin IV (Troughs 15‐20 mcg/mL)
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Enterobacteriaceae Septic Arthritis Tx
- • Ceftriaxone 1‐2g IV q12‐24h
- • Cefotaxime 2g IV q8h
- • Ciprofloxacin 400mg IV q8‐12h or 750mg PO q12h
- • Levofloxacin 750mg IV/PO daily
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P. aeruginosa Septic Arthritis Tx
- • Cefepime 2g IV q8h
- • May add aminoglycoside for double coverage
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Polymicrobial Septic Arthritis Tx
- • Ampicillin/sulbactam 1.5‐3g IV q4h
- • Clindamycin 600 mg IV q6‐8h PLUS cipro‐/levofloxacin
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CABG, Hip/Knee Arthroplasy Prophylaxis
- • Cefazolin
- • Cefuroxime
- • Vancomycin
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Colorectal Prophylaxis
- • Ampicillin/sulbactam
- • Cefotetan
- • Cefoxitin
- • Ertapenem
- • Cefazolin C metronidazole
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Hysterectomy Prophylaxis
- • Cefoxitin
- • Cefotetan
- • Cefazolin
- • Cefuroxime
- • Ampicillin/sulbactam
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