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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

osteo
Osteomyelitis