Sandbox/osteo

Hematogenous Osteomyelitis

Empiric Therapy

▸ Click on the following categories to expand treatment regimens.

Age   ▸  Newborn (<4 months)   ▸  Children (>4 months) - Adults   ▸  Adult (>21 years)

Staph aureus, gram-negative bacilli, group B strept Preferred Regimen ▸ Vancomycin 40 mg divided q6-8 hours PLUS ▸ Ceftazidime 50 mg IV q8h OR ▸ Cefepime 150 mg IV q8h Alternative Regimen ▸ Nafcillin OR ▸ Oxcacillin 37 mg q6h PLUS ▸ Ceftazidime 2 gm IV q8h OR Cefepime 2 gm IV q12h Staph aureus, group A strept, gram-negative bacilli Preferred Regimen ▸ Vancomycin 40 mg divided q6-8 hours PLUS ▸ Ceftazidime 50 mg IV q8h OR ▸ Cefepime 150 mg IV q8h Alternative Regimen ▸ Nafcillin OR ▸ Oxcacillin 37 mg q6h PLUS ▸ Ceftazidime 2 gm IV q8h OR Cefepime 2 gm IV q12h Staph aureus (most common) Preferred Regimen ▸ Vancomycin 1 gm IV q12h, if over 100 kg, 1.5 gm IV q12h Alternative Regimen ▸ Nafcillin 2 gm IV q4h OR ▸ Oxacillin 2 gm IV q4h

Specific Therapy

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Specific Etiology   ▸  Methicillin-sensitive S.aureus   ▸  Methicillin-resistant S.aureus   ▸  Salmonella; GN bacilli

MSSA Preferred Regimen ▸ Nafcillin 2 gm IV q4h OR ▸ Oxacillin 2 gm IV q4h OR ▸ Cefazolin IV q8h Alternative Regimen ▸ Vancomycin 1 gm q12h IV; if over 100 kg, 1.5 gm IV q12h MRSA Preferred Regimen ▸ Vancomycin 1 gm q12h IV Alternative Regimen ▸ Linezolid 600 mg q12h IV/po ± ▸ Rifampin 300 mg po/IV bid Salmonella (Gram-negative bacilli) Preferred Regimen ▸ Ciprofloxacin 400 mg IV q12h Alternative Regimen ▸ Levofloxacin 750 mg IV q24h

Contiguous Osteomyelitis Without Vascular Insufficiency

Empiric Therapy

▸ Click on the following categories to expand treatment regimens.

Specific Etiology   ▸  Methicillin-sensitive S.aureus   ▸  Methicillin-resistant S.aureus   ▸  Salmonella; GN bacilli

MSSA Preferred Regimen ▸ Nafcillin 2 gm IV q4h OR ▸ Oxacillin 2 gm IV q4h OR ▸ Cefazolin IV q8h Alternative Regimen ▸ Vancomycin 1 gm q12h IV; if over 100 kg, 1.5 gm IV q12h MRSA Preferred Regimen ▸ Vancomycin 1 gm q12h IV Alternative Regimen ▸ Linezolid 600 mg q12h IV/po ± ▸ Rifampin 300 mg po/IV bid Salmonella (Gram-negative bacilli) Preferred Regimen ▸ Ciprofloxacin 400 mg IV q12h Alternative Regimen ▸ Levofloxacin 750 mg IV q24h