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Latest revision as of 00:08, 30 July 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Alejandro Lemor, M.D. [2]Venkata Sivakrishna Kumar Pulivarthi M.B.B.S [3]

Overview

Acute nongonococcal septic arthritis is a medical emergency which causes severe joint destruction and may increase both morbidity and mortality. So prompt diagnosis and treatment with antibiotic therapy and prompt drainage which reduces long-term complications. Vancomycin is recommended as either empirical therapy for patients with Gram-positive cocci on a synovial fluid Gram stain or as a component of regimen for those with a negative Gram stain if methicillin-resistant Staphylococcus aureus (MRSA) is prevalent. If Gram-negative bacilli are observed, an anti-pseudomonal Cephalosporin (e.g., Ceftazidime, Cefepime) should be administered. Carbapenems should be considered in conditions such as colonization or infection by extended-spectrum β-lactamase–producing pathogens. The optimal duration of therapy for septic arthritis remains uncertain. A minimum 3- to 4 week course is suggested for septic arthritis caused by S. aureus or Gram-negative bacteria. The use of Corticosteroids or intraarticular antibiotics is not advisable.^[1]^[2]

Medical Therapy

Empiric treatment should be commenced as soon as possible after culture samples have been obtained. The choice of empiric antibiotics should be determined on the basis of:^[3]^[4]^[5]

Gram stain results of synovial fluid analysis
Local prevalence of organisms and resistance patterns
Predisposing factors including intravenous drug use, hospitalization, or colonization of infectious pathogens, and risk for methicillin-resistant Staphylococcus aureus (MRSA)

If the patient fails to respond to initial treatment, consider:^[3]

Misidentification of causative pathogen
Infection with atypical pathogen
Concurrent osteomyelitis
Occult nidus of infection

Intra-articular antibiotics are not useful as it may increase infection rate and also causes chemical synovitis and cartilage toxicity.^[6]

Methicillin-resistant Staphylococcus aureus (MRSA)

Patient at high risk of methicillin-resistant Staphylococcus aureus (MRSA) include:^[7]^[2]

Known MRSA colonization or infection
Recent hospitalization
Nursing-home resident
Presence of leg ulcers
Indwelling catheters

Drainage or debridement of the joint space should always be performed in septic arthritis caused by MRSA. A 3 or 4 week course of therapy with Vancomycin (15–20 mg/kg/dose IV every 8–12 hours in adults or 15 mg/kg/dose IV every 6 hours in children), Daptomycin (6 mg/kg/day IV every 24 hours in adults or 6–10 mg/kg/dose IV every 24 hours in children), Linezolid (600 mg PO/IV twice daily in adults or 10 mg/kg/dose PO/IV every 8 hours in children), Clindamycin (600 mg PO/IV every 8 hours in adults or 10–13 mg/kg/dose PO/IV every 6–8 hours in children), and Trimethoprim-Sulfamethoxazole (3.5–4.0 mg/kg PO/IV every 8–12 hours in adults) have been used with success. A prolonged treatment of 4 to 6 weeks may be required if the condition is complicated by osteomyelitis.^[8]^[9]

Antimicrobial Regimen – Empiric Therapy

Newborn (< 1 week)	Newborn (1–4 weeks)	Infants (1–3 months)	Children (3 months–14 years)	Adults
High Risk for MRSA Preferred Regimen Vancomycin 18 mg/kg/day IV q12h AND Cefotaxime 50 mg/kg IV q12h Low Risk for MRSA Cefotaxime 50 mg/kg IV q12h AND Nafcillin 25 mg/kg IV q8h or Oxacillin 25 mg/kg IV q8h	High Risk for MRSA Preferred Regimen Vancomycin 22 mg/kg/day IV q12h AND Cefotaxime 50 mg/kg IV q8h Alternative Regimen Clindamycin 5 mg/kg IV q8h Low Risk for MRSA Preferred Regimen Cefotaxime 50 mg/kg IV q8h AND Nafcillin 37 mg/kg IV q6h OR Oxacillin 37 mg/kg IV q6h Alternative Regimen Clindamycin 5 mg/kg IV q6h	High Risk for MRSA Preferred Regimen Vancomycin 40 mg/kg/day IV q6–8h AND Cefotaxime 50 mg/kg IV q8h Low Risk for MRSA Preferred Regimen Cefotaxime 50 mg/kg IV q8h AND Nafcillin 37 mg/kg IV q6h OR Oxacillin 37 mg/kg IV q6h Alternative Regimen Clindamycin 7.5 mg/kg IV q6h	Preferred Regimen Vancomycin 40 mg/kg/day IV q6–8h AND Cefotaxime 50 mg/kg IV q8h	Monoarticular At risk for sexually-transmitted disease Preferred Regimen Ceftriaxone 1 g IV q24h OR Cefotaxime 1 g IV q8h OR Ceftizoxime 1 g IV q8h Alternative Regimen Vancomycin 1 g IV q12h Not at risk for sexually-transmitted disease Preferred Regimen Vancomycin 1 g IV q12h AND Ceftriaxone 1 g IV q24h OR Cefotaxime 1 g IV q8h OR Ceftizoxime 1 g IV q8h Alternative Regimen Vancomycin 1 g IV q12h AND Ciprofloxacin 400 mg IV q12h OR Levofloxacin 750 mg IV q 24 h Polyarticular Preferred Regimen Ceftriaxone 1 g IV q24h

Antimicrobial Regimen – Synovial Fluid Gram Stain-Based Therapy

Gram stain result	First choice antibiotic	Second choice antibiotic
Negative Gram stain	Vancomycin 15–20 mg/kg q8–12h and Ceftazidime 2 g IV q8h or Cefepime 2 g IV q8–12h	Daptomycin 6-8 mg/kg IV q24h or Linezolid 600 mg IV/PO q12h and Piperacillin-Tazobactam 4.5 g IV q6h or Aztreonam 2 g IV q8h or Imipenem 500 mg IV q6h or Meropenem 1 g IV q8h or Doripenem 500 mg IV q8h or Carbapenems
Gram-positive cocci	Vancomycin 15–20 mg/kg q8–12h	Daptomycin 6-8 mg/kg IV q24h or Linezolid 600 mg IV/PO q12h
Gram-negative cocci	Ceftriaxone 1 g IV q24h or Cefotaxime 1 g IV q8h
Gram-negative bacilli	Ceftazidime 2 g IV q8h or Cefepime 2 g IV q8–12h or Piperacillin-Tazobactam 4.5 g IV q6h	Aztreonam 2 g IV q8h or Imipenem 500 mg IV q6h or Meropenem 1 g IV q8h or Doripenem 500 mg IV q8h or

Antimicrobial Regimen – Pathogen Based Therapy

Microorgnaism		First choice antibiotic	Second choice antibiotic
Staphylococcus aureus	Methicillin-sensitive	Nafcillin 2 g IV QID or Clindamycin 900 mg IV TID	Cefazolin 0.25–1 g IV/IM q6–8h, Vancomycin 500 mg IV q6h or 1 g IV q12h
Staphylococcus aureus	Methicillin-resistant	Vancomycin 15–20 mg/kg IV q8–12h in adults or 15 mg/kg IV q6h in children or Linezolid 600 mg PO/IV q12h in adults or 10 mg/kg PO/IV q8h in children	Sulfamethoxazole-trimethoprim 3.5–4.0 mg/kg PO/IV q8–12h in adults or Minocycline ± rifampin
Coagulase-negative Staphylococcus spp	Methicillin-sensitive	Nafcillin 2 g IV QID or Clindamycin 900 mg IV/IM TID	Cefazolin 0.25–1 g IV/IM q6–8h vancomycin 500 mg IV q6h or 1 g IV BD
Coagulase-negative Staphylococcus spp	Methicillin-resistant	Vancomycin 1 g BD or Linezolid 600 mg BD	Sulfamethoxazole-trimethoprim or Minocycline ± rifampin or Clindamycin
Group A streptococcus, Strep. pyogenes		Penicillin G 2 million IV/IM every 4 h or Ampicillin 2 g IV QID	Clindamycin 600–1200 mg/day IV/IM q6–12h Cefazolin 0.25–1 g IV/IM q6–8h
Group B streptococcus, Strep. agalactiae		Penicillin G 2 million IV/IM every 4 h or Ampicillin 2 g IV every 6 h	Clindamycin 600–1200 mg/day IV/IM q6–12h Cefazolin 0.25–1 g IV/IM q6–8h
Enterococcus spp.		Ampicillin 2 g IV QID or Vancomycin 1 g IV BD	Ampicillin-sulbactam 3 g IV QID Linezolid 600 mg PO/IV BD
Escherichia coli		Ampicillin-sulbactam 3 g IV QID	Cefazolin 0.25–1 g IV/IM q6–8h, levofloxacin 500–750 mg IV/PO OD Gentamicin 3–5 mg/kg/day IV q6–8h Sulfamethoxazole-trimethoprim 8–10 mg/kg/day IV/PO q6–12h
Proteus mirabilis		Ampicillin 2 g IV QID or Levofloxacin 500 mg IV/PO OD	Cefazolin 0.25–1 g IV/IM q6–8h Sulfamethoxazole-trimethoprim 8–10 mg/kg/day IV/PO q6–12h Gentamicin 3–5 mg/kg/day IV q6–8h
Proteus vulgaris, Proteus rettgeri, Morganella morganii		Cefotaxime 2 g IV QID Imipenem 500 mg IV QID, or Levofloxacin 500 mg IV/PO OD	Gentamicin 3–5 mg/kg/day IV q6–8h, or Ticarcillin-clavulanate 3.1 g IV q4–6h
Serratia marcescens		Cefotaxime 2 g IV QID	Levofloxacin 500 mg IV/PO OD Gentamicin 3–5 mg/kg/day IV q6–8h Imipenem 500 mg IV QID
Pseudomonas aeruginosa		Cefepime 2 gm IV BD or Piperacillin 3 gm IV QID or Imipenem 500 IV QID	Ticarcillin-clavulanate 3.1 g IV q4–6h Tobramycin 3-5 mg/kg/day IV q6–8h Amikacin 15 mg/kg/day IV/IM q8–12h Ciprofloxacin 400 mg IV q8–12h
Neisseria gonorrhea		Ceftriaxone 2 g IV OD or Cefotaxime 1 g TID	Levofloxacin 500 mg IV/PO OD Ampicillin 2 g IV QID
Bacteroides fragilis group		Clindamycin 900 mg IV/IM TID or Metronidazole 500 mg TID	Ampicillin-sulbactam 3 g IV QID or Ticarcillin-clavulanic acid 3.1 g IV QID
Brucella melitensis		Doxycycline 100 mg PO BD and Streptomycin 15 mg/kg IM QID or Rifampin 600–900 mg QID	Doxycycline 100 mg PO BD and Gentamicin 5 mg/kg IV QID
Haemophilus influenzae		Amoxicillin-Clavulanate 875/125 mg PO BD or Cefprozil 500 mg PO BD or Cefuroxime 500 mg PO BD or Cefdinir 600 mg PO OD	Levofloxacin 750 mg IV/PO OD or Moxifloxacin 400 mg IV/PO OD or Clarithromycin 500 mg PO BD
Morganella morganii		Cefotaxime 2 g IV QID or Imipenem 500 mg IV QID or Levofloxacin 500 mg IV/PO OD	Gentamicin 3–5 mg/kg/day IV q6–8h or Ticarcillin-Clavulanate 3.1 g IV q4–6h
Tropheryma whipplei		Penicillin G 2 million units IV q4h for 2 weeks and Streptomycin 1 g IM/IV OD for 2 weeks, then TMP-SMX 160mg/800mg PO OD for 1 year	Ceftriaxone 2 g IV OD, then TMP-SMX 160mg/800mg PO OD for 1 year
Borrelia burgdorferi		Amoxicillin 500 mg TID for 28 days or Doxycycline 100 mg BD for 28 days or Cefuroxime 500 mg BD for 28 days	Azithromycin 500 mg PO OD for 7–10 days or Clarithromycin 500 mg PO BD for 14–21 days or Erythromycin 500 mg PO QID for 14–21 days

Duration of Antimicrobial Therapy

Clinical Setting	Duration
Staphylococcus aureus infection	3–4 weeks
Streptococcus groups A, B, C, G infection	3–4 weeks
Gram-negative bacilli infection	4 weeks
Brucella infection	6 weeks
Borrelia burgdorferi infection	30 days
Mycobacterium tuberculosis infection	9 months
Candida albicans infection	6 weeks
Prosthetic joint infection	6 weeks
Post-intraarticular injection or post-arthroscopy	14 days

Prosthetic joint infection

Management of prosthetic joint infection typically requires both surgical intervention and extended courses of antimicrobial therapy. Options of surgical approach include

Debridement with retention of prosthesis:
- Two-stage procedure (removal of prosthesis and cement with debridement of infected tissue and placement of a joint spacer, followed by prolonged antibiotics and replacement of prosthesis)
- One-stage procedure (removal of prosthesis, debridement, and replacement of prosthesis in a single procedure)
Permanent resection arthroplasty and amputation.

The surgical decision should be made by orthopedic surgeon with specialty consultation, such as infectious disease or plastic surgery as necessary.^[10]

Antibiotic selection and duration are determined according to the causative organisms and the surgical intervention performed. Antimicrobial agent should achieve adequate tissue concentrations and be effective against slow-growing organisms and biofilms in conformity with local antibiogram. Liaison with microbiology services is recommended. Empiric antibiotics may be required while culture results are pending and for the duration of treatment for culture-negative infection. MRSA coverage with glycopeptide (e.g., Vancomycin, Daptomycin) or Gram-negative coverage with Ceftriaxone should be considered when necessary. Empiric or pathogen-directed antibiotic therapy is generally instituted following the procedure.^[11]

The duration of antibiotic treatment varies depending on the surgical procedure undertaken. A six-week course of parenteral therapy is preferred if an infected prosthesis is retained, while two to four weeks of intravenous antibiotics may be sufficient if revision arthroplasty is performed. Oral antibiotics are commonly prescribed for three to six months in the setting of retained prosthesis compared with six weeks for revision arthroplasty.^[12]

References

↑ Mathews, Catherine J.; Weston, Vivienne C.; Jones, Adrian; Field, Max; Coakley, Gerald (2010-03-06). "Bacterial septic arthritis in adults". Lancet. 375 (9717): 846–855. doi:10.1016/S0140-6736(09)61595-6. ISSN 1474-547X. PMID 20206778.
↑ ^2.0 ^2.1 Sharff KA, Richards EP, Townes JM (2013) Clinical management of septic arthritis. Curr Rheumatol Rep 15 (6):332. DOI:10.1007/s11926-013-0332-4 PMID: 23591823
↑ ^3.0 ^3.1 Shirtliff ME, Mader JT (2002) Acute septic arthritis. Clin Microbiol Rev 15 (4):527-44. PMID: 12364368
↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
↑ Mathews, Catherine J.; Weston, Vivienne C.; Jones, Adrian; Field, Max; Coakley, Gerald (2010-03-06). "Bacterial septic arthritis in adults". Lancet. 375 (9717): 846–855. doi:10.1016/S0140-6736(09)61595-6. ISSN 1474-547X. PMID 20206778.
↑ Stutz G, Kuster MS, Kleinstück F, Gächter A (2000) Arthroscopic management of septic arthritis: stages of infection and results. Knee Surg Sports Traumatol Arthrosc 8 (5):270-4. DOI:10.1007/s001670000129 PMID: 11061294
↑ Liu, Catherine; Bayer, Arnold; Cosgrove, Sara E.; Daum, Robert S.; Fridkin, Scott K.; Gorwitz, Rachel J.; Kaplan, Sheldon L.; Karchmer, Adolf W.; Levine, Donald P.; Murray, Barbara E.; J Rybak, Michael; Talan, David A.; Chambers, Henry F.; Infectious Diseases Society of America (2011-02-01). "Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 52 (3): –18-55. doi:10.1093/cid/ciq146. ISSN 1537-6591. PMID 21208910.
↑ Liu, Catherine; Bayer, Arnold; Cosgrove, Sara E.; Daum, Robert S.; Fridkin, Scott K.; Gorwitz, Rachel J.; Kaplan, Sheldon L.; Karchmer, Adolf W.; Levine, Donald P.; Murray, Barbara E.; J Rybak, Michael; Talan, David A.; Chambers, Henry F.; Infectious Diseases Society of America (2011-02-01). "Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 52 (3): –18-55. doi:10.1093/cid/ciq146. ISSN 1537-6591. PMID 21208910.
↑ Mathews, Catherine J.; Weston, Vivienne C.; Jones, Adrian; Field, Max; Coakley, Gerald (2010-03-06). "Bacterial septic arthritis in adults". Lancet. 375 (9717): 846–855. doi:10.1016/S0140-6736(09)61595-6. ISSN 1474-547X. PMID 20206778.
↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
↑ Matthews, Philippa C.; Berendt, Anthony R.; McNally, Martin A.; Byren, Ivor (2009). "Diagnosis and management of prosthetic joint infection". BMJ (Clinical research ed.). 338: –1773. ISSN 1756-1833. PMID 19482869.
↑ Matthews, Philippa C.; Berendt, Anthony R.; McNally, Martin A.; Byren, Ivor (2009). "Diagnosis and management of prosthetic joint infection". BMJ (Clinical research ed.). 338: –1773. ISSN 1756-1833. PMID 19482869.

[1] Mathews, Catherine J.; Weston, Vivienne C.; Jones, Adrian; Field, Max; Coakley, Gerald (2010-03-06). "Bacterial septic arthritis in adults". Lancet. 375 (9717): 846–855. doi:10.1016/S0140-6736(09)61595-6. ISSN 1474-547X. PMID 20206778.

[pmid23591823-2] 2.0 ^2.1 Sharff KA, Richards EP, Townes JM (2013) Clinical management of septic arthritis. Curr Rheumatol Rep 15 (6):332. DOI:10.1007/s11926-013-0332-4 PMID: 23591823

[pmid12364368-3] 3.0 ^3.1 Shirtliff ME, Mader JT (2002) Acute septic arthritis. Clin Microbiol Rev 15 (4):527-44. PMID: 12364368

[4] Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.

[5] Mathews, Catherine J.; Weston, Vivienne C.; Jones, Adrian; Field, Max; Coakley, Gerald (2010-03-06). "Bacterial septic arthritis in adults". Lancet. 375 (9717): 846–855. doi:10.1016/S0140-6736(09)61595-6. ISSN 1474-547X. PMID 20206778.

[pmid11061294-6] Stutz G, Kuster MS, Kleinstück F, Gächter A (2000) Arthroscopic management of septic arthritis: stages of infection and results. Knee Surg Sports Traumatol Arthrosc 8 (5):270-4. DOI:10.1007/s001670000129 PMID: 11061294

[7] Liu, Catherine; Bayer, Arnold; Cosgrove, Sara E.; Daum, Robert S.; Fridkin, Scott K.; Gorwitz, Rachel J.; Kaplan, Sheldon L.; Karchmer, Adolf W.; Levine, Donald P.; Murray, Barbara E.; J Rybak, Michael; Talan, David A.; Chambers, Henry F.; Infectious Diseases Society of America (2011-02-01). "Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 52 (3): –18-55. doi:10.1093/cid/ciq146. ISSN 1537-6591. PMID 21208910.

[8] Liu, Catherine; Bayer, Arnold; Cosgrove, Sara E.; Daum, Robert S.; Fridkin, Scott K.; Gorwitz, Rachel J.; Kaplan, Sheldon L.; Karchmer, Adolf W.; Levine, Donald P.; Murray, Barbara E.; J Rybak, Michael; Talan, David A.; Chambers, Henry F.; Infectious Diseases Society of America (2011-02-01). "Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 52 (3): –18-55. doi:10.1093/cid/ciq146. ISSN 1537-6591. PMID 21208910.

[9] Mathews, Catherine J.; Weston, Vivienne C.; Jones, Adrian; Field, Max; Coakley, Gerald (2010-03-06). "Bacterial septic arthritis in adults". Lancet. 375 (9717): 846–855. doi:10.1016/S0140-6736(09)61595-6. ISSN 1474-547X. PMID 20206778.

[10] Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.

[11] Matthews, Philippa C.; Berendt, Anthony R.; McNally, Martin A.; Byren, Ivor (2009). "Diagnosis and management of prosthetic joint infection". BMJ (Clinical research ed.). 338: –1773. ISSN 1756-1833. PMID 19482869.

[12] Matthews, Philippa C.; Berendt, Anthony R.; McNally, Martin A.; Byren, Ivor (2009). "Diagnosis and management of prosthetic joint infection". BMJ (Clinical research ed.). 338: –1773. ISSN 1756-1833. PMID 19482869.

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@@ Line 1: / Line 1: @@
 __NOTOC__
 {{Septic arthritis}}
-{{CMG}}; '''Associate Editor(s)-In-Chief:''' Jumana Nagarwala, M.D., ''Senior Staff Physician, Department of Emergency Medicine, Henry Ford Hospital''; {{CZ}}
+{{CMG}}; {{AE}}{{AL}}{{VSKP}}
 ==Overview==
-The treatment for septic arthritis requires an adequate drainage of the joint fluid and appropriate antibiotic therapy.
+Acute nongonococcal septic arthritis is a medical emergency which causes severe joint destruction and may increase both morbidity and mortality. So prompt diagnosis and treatment with antibiotic therapy and  prompt drainage which reduces long-term complications. '''[[Vancomycin]]''' is recommended as either empirical therapy for patients with [[Gram-positive cocci]] on a [[synovial fluid]] [[Gram stain]] or as a component of regimen for those with a negative [[Gram stain]] if [[MRSA|methicillin-resistant ''Staphylococcus aureus'' (MRSA)]] is prevalent.  If [[Gram-negative bacilli]] are observed, an anti-[[pseudomonal]] [[Cephalosporin]] (e.g., '''[[Ceftazidime]]''', '''[[Cefepime]]''') should be administered.  '''[[Carbapenems]]''' should be considered in conditions such as colonization or infection by [[ESBL|extended-spectrum β-lactamase]]–producing pathogens.  The optimal duration of therapy for septic arthritis remains uncertain.  A minimum 3- to 4 week course is suggested for septic arthritis caused by ''[[S. aureus]]'' or [[Gram-negative bacteria]].  The use of [[Corticosteroids]] or intraarticular [[antibiotics]] is not advisable.<ref>{{Cite journal| doi = 10.1016/S0140-6736(09)61595-6| issn = 1474-547X| volume = 375| issue = 9717| pages = 846–855| last1 = Mathews| first1 = Catherine J.| last2 = Weston| first2 = Vivienne C.| last3 = Jones| first3 = Adrian| last4 = Field| first4 = Max| last5 = Coakley| first5 = Gerald| title = Bacterial septic arthritis in adults| journal = Lancet| date = 2010-03-06| pmid = 20206778}}</ref><ref name="pmid23591823">Sharff KA, Richards EP, Townes JM (2013) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=23591823 Clinical management of septic arthritis.] ''Curr Rheumatol Rep'' 15 (6):332. [http://dx.doi.org/10.1007/s11926-013-0332-4 DOI:10.1007/s11926-013-0332-4] PMID: [https://pubmed.gov/23591823 23591823]</ref>
-Empiric therapy should be started after the collection joint fluid and blood sample for culture.
-There are no indications for intra-articular antibiotic therapy.
 ==Medical Therapy==
-Antibiotics are used to treat the infection and most of them achieve excellent bactericidal concentrations in the synovial fluid. The initial therapy depends on the clinical presentation, whether the patient is at risk for a Gonoccocal infection or not, and Gram stain of joint aspiration. The final therapy depends on the culture and sensitivity results. During the acute phase of the disease is important to keep the the joint still and raised, and the patient need to rest. Using cool compresses may help relieve pain. After the acute phase, exercise and physical therapy is important for the recovery process.  Severe cases may need surgery to drain the infected joint fluid.
+Empiric treatment should be commenced as soon as possible after culture samples have been obtained.  The choice of empiric antibiotics should be determined on the basis of:<ref name="pmid12364368">Shirtliff ME, Mader JT (2002) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12364368 Acute septic arthritis.] ''Clin Microbiol Rev'' 15 (4):527-44. PMID: [https://pubmed.gov/12364368 12364368]</ref><ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref><ref>{{Cite journal| doi = 10.1016/S0140-6736(09)61595-6| issn = 1474-547X| volume = 375| issue = 9717| pages = 846–855| last1 = Mathews| first1 = Catherine J.| last2 = Weston| first2 = Vivienne C.| last3 = Jones| first3 = Adrian| last4 = Field| first4 = Max| last5 = Coakley| first5 = Gerald| title = Bacterial septic arthritis in adults| journal = Lancet| date = 2010-03-06| pmid = 20206778}}</ref>
+* [[Gram stain]] results of [[synovial fluid]] analysis
+* Local prevalence of organisms and resistance patterns
+* Predisposing factors including intravenous drug use, hospitalization, or colonization of infectious pathogens, and risk for [[MRSA|methicillin-resistant ''Staphylococcus aureus'' (MRSA)]]
-====Duration of Antimicrobial Therapy====
+If the patient fails to respond to initial treatment, consider:<ref name="pmid12364368">Shirtliff ME, Mader JT (2002) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12364368 Acute septic arthritis.] ''Clin Microbiol Rev'' 15 (4):527-44. PMID: [https://pubmed.gov/12364368 12364368]</ref>
-* The duration of antimicrobial therapy should be individualized in accordance with patient's clinical response.
+* Misidentification of causative pathogen
+* Infection with atypical pathogen
+* Concurrent [[osteomyelitis]]
+* Occult nidus of infection
+Intra-articular antibiotics are not useful as it may increase infection rate and also causes [[Synovitis|chemical synovitis]] and [[Cartilage|cartilage toxicity]].<ref name="pmid11061294">Stutz G, Kuster MS, Kleinstück F, Gächter A (2000) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=11061294 Arthroscopic management of septic arthritis: stages of infection and results.] ''Knee Surg Sports Traumatol Arthrosc'' 8 (5):270-4. [http://dx.doi.org/10.1007/s001670000129 DOI:10.1007/s001670000129] PMID: [https://pubmed.gov/11061294 11061294]</ref>
-{| style="border: 2px solid #696969;"
+=====Methicillin-resistant ''Staphylococcus aureus'' (MRSA)=====
-|+ <SMALL>''Recommended Duration of Antimicrobial Therapy Based on Isolated Pathogen.''</SMALL>
+Patient at high risk of [[Methicillin-resistant staphylococcus aureus|methicillin-resistant Staphylococcus aureus]] (MRSA) include:<ref>{{Cite journal| doi = 10.1093/cid/ciq146| issn = 1537-6591| volume = 52| issue = 3| pages = –18-55| last1 = Liu| first1 = Catherine| last2 = Bayer| first2 = Arnold| last3 = Cosgrove| first3 = Sara E.| last4 = Daum| first4 = Robert S.| last5 = Fridkin| first5 = Scott K.| last6 = Gorwitz| first6 = Rachel J.| last7 = Kaplan| first7 = Sheldon L.| last8 = Karchmer| first8 = Adolf W.| last9 = Levine| first9 = Donald P.| last10 = Murray| first10 = Barbara E.| last11 = J Rybak| first11 = Michael| last12 = Talan| first12 = David A.| last13 = Chambers| first13 = Henry F.| last14 = Infectious Diseases Society of America| title = Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children| journal = Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America| date = 2011-02-01| pmid = 21208910}}</ref><ref name="pmid23591823">Sharff KA, Richards EP, Townes JM (2013) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=23591823 Clinical management of septic arthritis.] ''Curr Rheumatol Rep'' 15 (6):332. [http://dx.doi.org/10.1007/s11926-013-0332-4 DOI:10.1007/s11926-013-0332-4] PMID: [https://pubmed.gov/23591823 23591823]</ref>
-| style="background: #A5B2D6; border: 0px solid #696969; padding: 0 5px; width: 200px"| '''''Microorganism''''' || style="background: #A5B2D6; border: 0px solid #696969; padding: 0 5px; width: 200px" | '''Duration of Therapy'''
+* Known [[Methicillin-resistant staphylococcus aureus|MRSA]] colonization or infection
-|-
+* Recent hospitalization
-| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left |&nbsp;▸&nbsp;'''''[[Staphylococcus aureus]]''''' || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ''''' 3-4 weeks'''''
+* Nursing-home resident
-|-
+* Presence of leg ulcers
-| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left |&nbsp;▸&nbsp;'''''[[Streptococcus|Streptococcus groups A, B, C, G]]''''' || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ''''' 3-4 weeks'''''
+* Indwelling [[catheters]]
-|-
-| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left |&nbsp;▸&nbsp;'''''[[Gram-negative bacilli]]''''' || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ''''' 4 weeks'''''
+Drainage or [[debridement]] of the joint space should always be performed in septic arthritis caused by [[MRSA]].  A 3 or 4 week course of therapy with '''[[Vancomycin]]''' (15–20 mg/kg/dose IV every 8–12 hours in adults or 15 mg/kg/dose IV every 6 hours in children), '''[[Daptomycin]]''' (6 mg/kg/day IV every 24 hours in adults or 6–10 mg/kg/dose IV every 24 hours in children), '''[[Linezolid]]''' (600 mg PO/IV twice daily in adults or 10 mg/kg/dose PO/IV every 8 hours in children), '''[[Clindamycin]]''' (600 mg PO/IV every 8 hours in adults or 10–13 mg/kg/dose PO/IV every 6–8 hours in children), and '''[[Trimethoprim-Sulfamethoxazole]]''' (3.5–4.0 mg/kg PO/IV every 8–12 hours in adults) have been used with success.  A prolonged treatment of 4 to 6 weeks may be required if the condition is complicated by [[osteomyelitis]].<ref>{{Cite journal| doi = 10.1093/cid/ciq146| issn = 1537-6591| volume = 52| issue = 3| pages = –18-55| last1 = Liu| first1 = Catherine| last2 = Bayer| first2 = Arnold| last3 = Cosgrove| first3 = Sara E.| last4 = Daum| first4 = Robert S.| last5 = Fridkin| first5 = Scott K.| last6 = Gorwitz| first6 = Rachel J.| last7 = Kaplan| first7 = Sheldon L.| last8 = Karchmer| first8 = Adolf W.| last9 = Levine| first9 = Donald P.| last10 = Murray| first10 = Barbara E.| last11 = J Rybak| first11 = Michael| last12 = Talan| first12 = David A.| last13 = Chambers| first13 = Henry F.| last14 = Infectious Diseases Society of America| title = Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children| journal = Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America| date = 2011-02-01| pmid = 21208910}}</ref><ref>{{Cite journal| doi = 10.1016/S0140-6736(09)61595-6| issn = 1474-547X| volume = 375| issue = 9717| pages = 846–855| last1 = Mathews| first1 = Catherine J.| last2 = Weston| first2 = Vivienne C.| last3 = Jones| first3 = Adrian| last4 = Field| first4 = Max| last5 = Coakley| first5 = Gerald| title = Bacterial septic arthritis in adults| journal = Lancet| date = 2010-03-06| pmid = 20206778}}</ref>
-|-
-| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left |&nbsp;▸&nbsp;'''''[[Brucella]]''''' || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ''''' 6 weeks'''''
+==Antimicrobial Regimen – Empiric Therapy==
-|-
+{| class="wikitable"
-| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left |&nbsp;▸&nbsp;'''''[[Borrelia burgdorferi]]''''' || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ''''' 30 days'''''
+! style="width: 20%;" | '''Newborn (&lt; 1 week)'''
-|-
+! style="width: 20%;" | '''Newborn (1–4 weeks)'''
-| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left |&nbsp;▸&nbsp;'''''[[Mycobacterium tuberculosis]]''''' || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ''''' 9 months'''''
+! style="width: 20%;" | '''Infants (1–3 months)'''
-|-
+! style="width: 20%;" | '''Children (3 months–14 years)'''
-| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left |&nbsp;▸&nbsp;'''''[[Candida albicans]]''''' || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ''''' 6 weeks'''''
+! style="width: 20%;" | '''Adults'''
 |-
+| valign = top |
+'''High Risk for MRSA'''
+* '''Preferred Regimen'''
+** [[Vancomycin]] 18 mg/kg/day IV q12h {{and}}
+** [[Cefotaxime]] 50 mg/kg IV q12h
+'''Low Risk for MRSA'''
+** [[Cefotaxime]] 50 mg/kg IV q12h {{and}}
+** [[Nafcillin]] 25 mg/kg IV q8h or [[Oxacillin]] 25 mg/kg IV q8h
+| valign = top |
+'''High Risk for MRSA'''
+* '''Preferred Regimen'''
+** [[Vancomycin]] 22 mg/kg/day IV q12h {{and}}
+** [[Cefotaxime]] 50 mg/kg IV q8h
+* '''Alternative Regimen'''
+** [[Clindamycin]] 5 mg/kg IV q8h
+'''Low Risk for MRSA'''
+* '''Preferred Regimen'''
+** [[Cefotaxime]] 50 mg/kg IV q8h {{and}}
+** [[Nafcillin]] 37 mg/kg IV q6h {{or}} [[Oxacillin]] 37 mg/kg IV q6h
+* '''Alternative Regimen'''
+** [[Clindamycin]] 5 mg/kg IV q6h
+| valign = top |
+'''High Risk for MRSA'''
+* '''Preferred Regimen'''
+** [[Vancomycin]] 40 mg/kg/day IV q6–8h {{and}}
+** [[Cefotaxime]] 50 mg/kg IV q8h
+'''Low Risk for MRSA'''
+* '''Preferred Regimen'''
+** [[Cefotaxime]] 50 mg/kg IV q8h {{and}}
+** [[Nafcillin]] 37 mg/kg IV q6h {{or}} [[Oxacillin]] 37 mg/kg IV q6h
+* '''Alternative Regimen'''
+** [[Clindamycin]] 7.5 mg/kg IV q6h
+| valign = top |
+'''Preferred Regimen'''
+* [[Vancomycin]] 40 mg/kg/day IV q6–8h {{and}}
+* [[Cefotaxime]] 50 mg/kg IV q8h
+| valign = top |
+'''Monoarticular'''
+* '''At risk for sexually-transmitted disease'''
+**'''Preferred Regimen'''
+*** [[Ceftriaxone]] 1 g IV q24h {{or}} [[Cefotaxime]] 1 g IV q8h {{or}} [[Ceftizoxime]] 1 g IV q8h
+**'''Alternative Regimen'''
+*** [[Vancomycin]] 1 g IV q12h
+* '''Not at risk for sexually-transmitted disease'''
+**'''Preferred Regimen'''
+*** [[Vancomycin]] 1 g IV q12h {{and}}
+*** [[Ceftriaxone]] 1 g IV q24h {{or}} [[Cefotaxime]] 1 g IV q8h {{or}} [[Ceftizoxime]] 1 g IV q8h
+**'''Alternative Regimen'''
+*** [[Vancomycin]] 1 g IV q12h {{and}}
+*** [[Ciprofloxacin]] 400 mg IV q12h {{or}} [[Levofloxacin]] 750 mg IV q 24 h
+'''Polyarticular'''
+*'''Preferred Regimen'''
+** [[Ceftriaxone]] 1 g IV q24h
 |}
-<br>
-{| style="border: 2px solid #696969;"
+==Antimicrobial Regimen – Synovial Fluid Gram Stain-Based Therapy==
-| style="background: #A5B2D6; border: 0px solid #696969; padding: 0 5px; width: 200px"| '''''Special cases''''' || style="background: #A5B2D6; border: 0px solid #696969; padding: 0 5px; width: 200px" | '''Duration of Therapy'''
+{| border="1"
-|-
+! colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|'''Gram stain result'''}}
-| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left |&nbsp;▸&nbsp;'''''Prosthetic joint infection''''' || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ''''' 6 weeks'''''
+!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|'''First choice antibiotic'''}}
-|-
+!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|'''Second choice antibiotic'''}}
-| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left |&nbsp;▸&nbsp;'''''Post intra-articular injection or post-arthroscopy infection''''' || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left |  '''''14 days'''''
 |-
-|}
+!Negative Gram stain
+|
-==Empiric Therapy <SMALL><SMALL><SMALL><SMALL><SMALL>Adapted from Lancet 375:846, 2010.<ref name="Mathews-2010">{{Cite journal  | last1 = Mathews | first1 = CJ. | last2 = Weston | first2 = VC. | last3 = Jones | first3 = A. | last4 = Field | first4 = M. | last5 = Coakley | first5 = G. | title = Bacterial septic arthritis in adults. | journal = Lancet | volume = 375 | issue = 9717 | pages = 846-55 | month = Mar | year = 2010 | doi = 10.1016/S0140-6736(09)61595-6 | PMID = 20206778 }}</ref></SMALL></SMALL></SMALL></SMALL></SMALL>==
+* [[Vancomycin]] 15–20 mg/kg q8–12h and
-<SMALL><font color="#FF4C4C">'''▸ Click on the following categories to expand treatment regimens.'''</font></SMALL>
-{|
+* [[Ceftazidime]] 2 g IV q8h or [[Cefepime]] 2 g IV q8–12h
-| valign=top |
+|
-<div style="border-radius: 5px 5px 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #A1BCDD; text-align: center;">
+* [[Daptomycin]] 6-8 mg/kg IV q24h or [[Linezolid]] 600 mg IV/PO q12h
-<font color="#FFF">
-&nbsp;&nbsp;&nbsp;&nbsp;'''Pediatric'''
-</font>
-</div>
-<div class="mw-customtoggle-table01" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
+and
-<font color="#FFF">
-&nbsp;&nbsp;&nbsp;&nbsp;'''''Newborns (< 1 week)'''''
-</font>
-</div>
-<div class="mw-customtoggle-table02" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
+* [[Piperacillin-Tazobactam]] 4.5 g IV q6h or [[Aztreonam]] 2 g IV q8h or [[Imipenem]] 500 mg IV q6h or [[Meropenem]] 1 g IV q8h or [[Doripenem]] 500 mg IV q8h or [[Carbapenems]]
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Newborns (1 -4 week)'''''
-</font>
-</div>
-<div class="mw-customtoggle-table03" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Infants (1 - 3 months)'''''
-</font>
-</div>
-<div class="mw-customtoggle-table04" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Children (3 mo - 14 yr) '''''
-</font>
-</div>
-<div style="border-radius: 0 0 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #A1BCDD; text-align: center;">
-<font color="#FFF">
-&nbsp;&nbsp;&nbsp;&nbsp;'''Adults'''
-</font>
-</div>
-<div class="mw-customtoggle-table05" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Acute Monoarticular'''''
-</font>
-</div>
-<div class="mw-customtoggle-table06" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Chronic Monoarticular'''''
-</font>
-</div>
-<div class="mw-customtoggle-table07" style="cursor: pointer; border-radius: 0 0 5px 5px; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Polyarticular'''''
-</font>
-</div>
-| valign=top |
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table01" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Newborn (< 1 week) ''}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | High suspicion of MRSA
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 18 mg/kg IV divided q12h '''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[ Cefotaxime]] 50 mg/kg IV q12h'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Low suspicion of MRSA
 |-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Nafcillin]] 25 mg/kg q8h''''' <br> OR <br> ▸ '''''[[Oxacillin]] 25 mg/kg q8h'''''
+!Gram-positive cocci
+|
+* [[Vancomycin]] 15–20 mg/kg q8–12h
+|
+* [[Daptomycin]] 6-8 mg/kg IV q24h or
+* [[Linezolid]] 600 mg IV/PO q12h
 |-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS
+!Gram-negative cocci
-|-
+| colspan="2" |
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[ Cefotaxime]] 50 mg/kg IV q12h'''''
+* [[Ceftriaxone]] 1 g IV q24h or [[Cefotaxime]] 1 g IV q8h
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen <br> (For low suspicion of MRSA)
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Clindamycin]] 5mg/kg q8h'''''
 |-
-|}
+!Gram-negative bacilli
+|
+* [[Ceftazidime]] 2 g IV q8h or
+* [[Cefepime]] 2 g IV q8–12h or
+* [[Piperacillin-Tazobactam]] 4.5 g IV q6h
+|
+* [[Aztreonam]] 2 g IV q8h or
+* [[Imipenem]] 500 mg IV q6h or
+* [[Meropenem]] 1 g IV q8h or
+* [[Doripenem]] 500 mg IV q8h or
 |}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table02" style="background: #FFFFFF;"
+==Antimicrobial Regimen – Pathogen Based Therapy==
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Newborn (1 - 4 weeks)''}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | High suspicion of MRSA
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 22 mg/kg q12h '''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[ Cefotaxime]] 50 mg/kg IV q8h'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Low suspicion of MRSA
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Nafcillin]] 37 mg/kg q6h '''''<br> OR <br> ▸ '''''[[Oxacillin]] 37 mg/kg q6h'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[ Cefotaxime]] 50 mg/kg IV q8h'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen <br> (For low suspicion of MRSA)
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Clindamycin]] 5mg/kg q6h'''''
-|-
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table03" style="background: #FFFFFF;"
+{| border="1"
-| valign=top |
+! colspan="2" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|'''Microorgnaism'''}}
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
+!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|'''First choice antibiotic'''}}
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Infants (1- 3 months) ''}}
+!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|'''Second choice antibiotic'''}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | High suspicion of MRSA
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 40 mg/kg/day divided q6-8h'''''
 |-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS
+! rowspan="2" |[[Staphylococcus aureus]]
+!Methicillin-sensitive
+|
+* [[Nafcillin]] 2 g IV QID or
+* [[Clindamycin]] 900 mg IV TID
+|
+* [[Cefazolin]] 0.25–1 g IV/IM q6–8h,
+* [[Vancomycin]] 500 mg IV q6h or 1 g IV q12h
 |-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[ Cefotaxime]] 50 mg/kg IV q8h'''''
+!Methicillin-resistant
+|
+* [[Vancomycin]]  15–20 mg/kg IV q8–12h in adults or 15 mg/kg IV q6h in children or
+* [[Linezolid]] 600 mg PO/IV q12h in adults or 10 mg/kg PO/IV q8h in children
+|
+* [[Sulfamethoxazole-Trimethoprim|Sulfamethoxazole-trimethoprim]] 3.5–4.0 mg/kg PO/IV q8–12h in adults or
+* [[Minocycline]] ± [[rifampin]]
 |-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Low suspicion of MRSA
+! rowspan="2" |[[Coagulase-negative Staphylococcus|Coagulase-negative Staphylococcus spp]]
+!Methicillin-sensitive
+|
+* [[Nafcillin]] 2 g IV QID or
+* [[Clindamycin]] 900 mg IV/IM TID
+|
+* [[Cefazolin]] 0.25–1 g IV/IM q6–8h
+* [[vancomycin]] 500 mg IV q6h or 1 g IV BD
 |-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Nafcillin]] 37 mg/kg q6h (max 8-12 g/day)'''''  <br> OR <br> ▸ '''''[[Oxacillin]] 37 mg/kg q6h (max 8-12 g/day)'''''
+!Methicillin-resistant
-|-
+|
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS
+* [[Vancomycin]] 1 g BD or
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[ Cefotaxime]] 50 mg/kg IV q8h'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen <br> (For low suspicion of MRSA)
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Clindamycin]] 7.5mg/kg q6h'''''
-|-
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table04" style="background: #FFFFFF;"
+* [[Linezolid]] 600 mg BD
-| valign=top |
+|
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
+* [[Sulfamethoxazole-Trimethoprim|Sulfamethoxazole-trimethoprim]] or
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Children (3 mo - 14 yr)''}}
+* [[Minocycline]] ± [[rifampin]] or [[Clindamycin]]
 |-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
+! colspan="2" |[[Group A streptococcus]], [[Streptococcal|Strep. pyogenes]]
-|-
+|
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 40 mg/kg/day IV q6-8h'''''
+* [[Penicillin]] G 2 million IV/IM every 4 h or
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 50 mg/kg IV q8h'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Linezolid]] 10 mg/kg IV q8h''''' <br> OR <br>▸ ''''' [[Clindamycin]] 7.5 mg/kg IV q6h'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Aztreonam]] 30 mg/kg IV q6h'''''
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table05" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
+* [[Ampicillin]] 2 g IV QID
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Acute Monoarticular''}}
+|
-|-
+* [[Clindamycin]] 600–1200 mg/day IV/IM q6–12h
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
+* [[Cefazolin]] 0.25–1 g IV/IM q6–8h
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | At risk for Gonococcal infection
 |-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ceftriaxone]] 1 g IV q24h''''' <BR> OR <BR> ▸ '''''[[Cefotaxime]] 1 g IV q8h''''' <BR> OR <BR> ▸ '''''[[Ceftizoxime]] 1 g IV q8h'''''
+! colspan="2" |[[Group B streptococcal infection|Group B streptococcus]], [[Streptococcus|Strep. agalactiae]]
-|-
+|
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Not at risk for Gonococcal infection
+* [[Penicillin]] G 2 million IV/IM every 4 h or
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 15-20 mg/kg IV q8-12h'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ceftriaxone]] 1g IV q24h''''' <br> OR <br> ▸ '''''[[Cefepime]] 2g IV q8h '''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen <br> (If not at risk for Gonococcal infection)
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 15-20 mg/kg IV q8-12h'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ciprofloxacin]] 400 mg IV q12h <br> OR <br>▸ '''''[[Levofloxacin ]] 750 mg IV q24h'''''
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table06" style="background: #FFFFFF;"
+* [[Ampicillin]] 2 g IV every 6 h
-| valign=top |
+|
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
+* [[Clindamycin]] 600–1200 mg/day IV/IM q6–12h
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Chronic Monoarticular''}}
+* [[Cefazolin]] 0.25–1 g IV/IM q6–8h
 |-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center |  Empirical therapy is not recommended. <br> Treatment should be addressed for the specific etiology
+! colspan="2" |[[Enterococcus|Enterococcus spp]].
-|-
+|
-|}
+* [[Ampicillin]] 2 g IV QID or
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table07" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Polyarticular''}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ceftriaxone]] 1 gm IV q24h'''''
-|-
-|}
-|}
-|}
-==Synovial Fluid Gram Stain-Based Therapy <SMALL><SMALL><SMALL><SMALL><SMALL>Adapted from Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases<ref>{{Cite book  | last1 = Mandell | first1 = Gerald L. | last2 = Bennett | first2 = John E. (John Eugene) | last3 = Dolin | first3 = Raphael. | title = Mandell, Douglas, and Bennett's principles and practice of infectious disease | date = 2010 | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | isbn = <!DOCTYPE | pages =  }}</ref></SMALL></SMALL></SMALL></SMALL></SMALL>==
-<SMALL><font color="#FF4C4C">'''▸ Click on the following categories to expand treatment regimens.'''</font></SMALL>
-{|
+* [[Vancomycin]] 1 g IV  BD
-| valign=top |
+|
-<div style="border-radius: 5px 5px 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #A1BCDD; text-align: center;">
+* [[Ampicillin-Sulbactam|Ampicillin-sulbactam]] 3 g IV QID
-<font color="#FFF">
+* [[Linezolid]] 600 mg PO/IV BD
-'''Gram-Positive'''
-</font>
-</div>
-<div class="mw-customtoggle-table08" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''Gram-Positive Cocci'''
-</font>
-</div>
-<div class="mw-customtoggle-table50" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''Gram-Positive Bacilli'''
-</font>
-</div>
-<div style="border-radius: 0 0 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #A1BCDD; text-align: center;">
-<font color="#FFF">
-'''Gram-Negative'''
-</font>
-</div>
-<div class="mw-customtoggle-table09" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''Gram-Negative Cocci'''
-</font>
-</div>
-<div class="mw-customtoggle-table10" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''Gram-Negative Rods'''
-</font>
-</div>
-<div style="border-radius: 0 0 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #A1BCDD; text-align: center;">
-<font color="#FFF">
-'''Negative Gram Stain'''
-</font>
-</div>
-<div class="mw-customtoggle-table11" style="cursor: pointer; border-radius: 0 0 5px 5px; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''Negative Gram Stain'''
-</font>
-</div>
-| valign=top |
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table08" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Gram-Positive Cocci}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 15-20 mg/kg IV q8—12h''''' <SMALL>(trough 15—20 μg/mL)</SMALL>
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen <br> (For patients allergic to vancomycin)
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Linezolid]] 600 mg PO/IV q12h '''''<BR> OR <BR> ▸ '''''[[Daptomycin]] 6 mg/kg IV q24h'''''
-|-
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table50" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Gram-Positive Bacilli}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Penicillin G]] 2 MU IV q4h '''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 15-20 mg/kg IV q8—12h''''' <SMALL>(trough 15—20 μg/mL)</SMALL><BR> OR <BR> ▸ '''''[[Nafcillin]] 1.5-2 g IV q4h'''''
-|-
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table09" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Gram-Negative Cocci}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ceftriaxone]] 1 g IV q24h'''''
-|-
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table10" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Gram-Negative Rods}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ceftazidime]] 2 g IV q8h'''''<BR> OR <BR> ▸ '''''[[Cefepime]] 2g IV q12h'''''<BR> OR <BR>
-▸ '''''[[Piperacillin-tazobactam]] 4.5 g q6h ''''' <BR> OR <BR> ▸ '''''[[Imipenem]] 500 mg IV q6h''''' <BR> OR <BR> ▸ '''''[[Meropenem]] 1 g IV q8h'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen (For patients allergic to cephalosporins)<br>
 |-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Aztreonam]] 2 g q8h'''''<BR> OR <BR> ▸ '''''[[Ciprofloxacin]] 400 mg IV q12h'''''<BR> OR <BR> ▸ '''''[[Levofloxacin]] 750 mg IV q24h'''''
+! colspan="2" |[[Escherichia coli]]
+|
+* [[Ampicillin-Sulbactam|Ampicillin-sulbactam]] 3 g IV QID
+|
+* [[Cefazolin]] 0.25–1 g IV/IM q6–8h, levofloxacin 500–750 mg IV/PO OD
+* [[Gentamicin]] 3–5 mg/kg/day IV q6–8h
+* [[Sulfamethoxazole-Trimethoprim|Sulfamethoxazole-trimethoprim]] 8–10 mg/kg/day IV/PO q6–12h
 |-
-|}
+! colspan="2" |[[Proteus mirabilis]]
-|}
+|
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table11" style="background: #FFFFFF;"
+* [[Ampicillin]] 2 g IV QID or
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Negative Gram Stain}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 15-20 mg/kg IV q8—12h'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left |▸ '''''[[Ceftazidime]] 2 g IV q8h'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ciprofloxacin]] 750 mg IV q12h'''''<BR> OR <BR> ▸ '''''[[Levofloxacin]] 750 mg IV q24h''''' <BR> OR <BR> ▸ '''''[[Tobramycin]] 300mg q12h'''''<BR> OR <BR> ▸ '''''[[Gentamycin]] 5-7 mg/kg once daily or 5 mg/kg divided in 3 doses/day'''''
-|-
-|}
-|}
-|}
-==Pathogen-Based Therapy — Bacteria <SMALL><SMALL><SMALL><SMALL><SMALL>Adapted from Bacterial septic arthritis in adults.<ref name="www.ncbi.nlm.nih.gov">{{Cite web  | last =  | first =  | title = Bacterial septic arthritis in adults. [Lancet. 2010] - PubMed - NCBI | url = http://www.ncbi.nlm.nih.gov/pubmed/20206778 | publisher =  | date =  | accessdate = 20 May 2014 }}</ref> and CLIN. MICROBIOL. REV. Acute Septic Arthritis  <ref name="ShirtliffMader2002">{{cite journal|last1=Shirtliff|first1=M. E.|last2=Mader|first2=J. T.|title=Acute Septic Arthritis|journal=Clinical Microbiology Reviews|volume=15|issue=4|year=2002|pages=527–544|issn=0893-8512|doi=10.1128/CMR.15.4.527-544.2002}}</ref></SMALL></SMALL></SMALL></SMALL></SMALL>==
-<SMALL><font color="#FF4C4C">'''▸ Click on the following categories to expand treatment regimens.'''</font></SMALL>
-{|
-| valign=top |
-<div style="border-radius: 5px 5px 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #A1BCDD; text-align: center;">
-<font color="#FFF">
-'''Bacteria'''
-</font>
-</div>
-<div class="mw-customtoggle-table00" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Brucella'''''
-</font>
-</div>
-<div class="mw-customtoggle-table16" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''E. coli'''''
-</font>
-</div>
-<div class="mw-customtoggle-table24" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Enterococcus spp.'''''
-</font>
-</div>
-<div class="mw-customtoggle-table19" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Haemophilus influenzae'''''
-</font>
-</div>
-<div class="mw-customtoggle-table18" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Neisseria gonorrhoeae'''''
-</font>
-</div>
-<div class="mw-customtoggle-table25" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Proteus mirabilis'''''
-</font>
-</div>
-<div class="mw-customtoggle-table17" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Pseudomonas aeruginosa'''''
-</font>
-</div>
-<div class="mw-customtoggle-table12" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Staphylococcus aureus'''''
-</font>
-</div>
-<div class="mw-customtoggle-table13" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Staphylococcus epidermidis'''''
-</font>
-</div>
-<div class="mw-customtoggle-table15" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Streptococcus groups A, B, C, G'''''
-</font>
-</div><div class="mw-customtoggle-table23" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''T. whipplei'''''
-</font>
-</div>
-<div style="border-radius: 5px 5px 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #A1BCDD; text-align: center;">
-<font color="#FFF">
-'''Mycobacteria'''
-</font>
-</div>
-<div class="mw-customtoggle-table20" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Mycobacterium tuberculosis'''''
-</font>
-</div>
-<div style="border-radius: 5px 5px 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #A1BCDD; text-align: center;">
+* [[Levofloxacin]] 500 mg IV/PO OD
-<font color="#FFF">
+|
-'''Spirochetes'''
+* [[Cefazolin]] 0.25–1 g IV/IM q6–8h
-</font>
+* [[Sulfamethoxazole-Trimethoprim|Sulfamethoxazole-trimethoprim]] 8–10 mg/kg/day IV/PO q6–12h
-</div>
+* [[Gentamicin]] 3–5 mg/kg/day IV q6–8h
-<div class="mw-customtoggle-table21" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Borrelia burgdorferi'''''
-</font>
-</div>
-<div class="mw-customtoggle-table22" style="cursor: pointer; border-radius: 0 0 5px 5px; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Treponema pallidum'''''
-</font>
-</div>
-| valign=top |
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table00" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Brucella''}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Doxycycline]] 100 mg PO q12h x 6 weeks'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left |PLUS
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Streptomycin]] 1 g IM/IV q24h x 2-3 weeks''''' <br> OR <br> ▸ '''''[[Rifampin]] 600-900 mg q24h x 6 weeks'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Doxycycline]] 100 mg PO q12h x 6 weeks'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left |PLUS
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Gentamicin]] 5 mg/kg IM/IV x 7-10 days'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | <SMALL>Adapted PLoS Med. Dec 2007; 4(12): e317.<ref name="ArizaBosilkovski2007">{{cite journal|last1=Ariza|first1=Javier|last2=Bosilkovski|first2=Mile|last3=Cascio|first3=Antonio|last4=Colmenero|first4=Juan D.|last5=Corbel|first5=Michael J.|last6=Falagas|first6=Matthew E.|last7=Memish|first7=Ziad A.|last8=Roushan|first8=Mohammad Reza Hasanjani|last9=Rubinstein|first9=Ethan|last10=Sipsas|first10=Nikolaos V.|last11=Solera|first11=Javier|last12=Young|first12=Edward J.|last13=Pappas|first13=Georgios|title=Perspectives for the Treatment of Brucellosis in the 21st Century: The Ioannina Recommendations|journal=PLoS Medicine|volume=4|issue=12|year=2007|pages=e317|issn=1549-1277|doi=10.1371/journal.pmed.0040317}}</ref>
-</SMALL>
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table12" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Staphylococcus aureus, Methicillin sensitive''}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Nafcillin]] 1.5-2 g IV q4h'''''<br> OR <br> ▸ '''''[[Oxacillin]] 1.5-2 g IV q4h'''''  <br> OR <br> ▸ '''''[[Cefazolin]] 1 g IV q8h '''''<br> OR <br> ▸ '''''[[Flucloxacillin]] 2 g IV q6h '''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Dicloxacillin]] 500 mg PO q6h''''' <br> OR <br> ▸ '''''[[Cephalexin]] 500 mg PO q6h''''' <br> OR <br> ▸ '''''[[Clindamycin]] 300 mg PO q8h''''' <br> OR <br> ▸ '''''[[TMP-SMX]] 160/800 mg PO q12h'''''
-|-
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Staphylococcus aureus, Methicillin resistant''}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 15-20 mg/kg IV q8-12h'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸  '''''[[Daptomycin]] 6 mg IV q24h''''' <br> OR <br> ▸  '''''[[Linezolid]] 600 mg IV/PO q12h'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | <SMALL>Adapted from IDSA Guidelines for MRSA<ref name="LiuBayer2011">{{cite journal|last1=Liu|first1=C.|last2=Bayer|first2=A.|last3=Cosgrove|first3=S. E.|last4=Daum|first4=R. S.|last5=Fridkin|first5=S. K.|last6=Gorwitz|first6=R. J.|last7=Kaplan|first7=S. L.|last8=Karchmer|first8=A. W.|last9=Levine|first9=D. P.|last10=Murray|first10=B. E.|last11=Rybak|first11=M. J.|last12=Talan|first12=D. A.|last13=Chambers|first13=H. F.|title=Clinical Practice Guidelines by the Infectious Diseases Society of America for the Treatment of Methicillin-Resistant Staphylococcus aureus Infections in Adults and Children|journal=Clinical Infectious Diseases|volume=52|issue=3|year=2011|pages=e18–e55|issn=1058-4838|doi=10.1093/cid/ciq146}}</ref></SMALL>
-|-
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table13" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Staphylococcus epidermidis''}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Nafcillin]] 1.5-2 g IV q4h'''''<br> OR <br> ▸ '''''[[Oxacillin]] 1.5-2 g IV q4h'''''  <br> OR <br> ▸ '''''[[Cefazolin]] 1 g IV q8h '''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen <br> Methicillin-resistant
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 15-20 mg/kg IV q8h'''''|}
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table15" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Streptococcus groups A, B, C, G''}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Penicillin G]] 20 MU IV q24h or divided in 6 doses/day'''''<BR> OR <br> ▸ '''''[[Ceftriaxone]] 2 g IV or IM q24h'''''<BR> OR <br> ▸ '''''[[Cefotaxime]] 2g IV q8h'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 15mg/kg IV q12h'''''
-|-
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table16" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''E. coli''}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸'''''[[Ampicillin sulbactam]] 3g IV q6h'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefazolin]] 1g IV q8 h ''''' <br> OR <br> ▸ '''''[[Levofloxacin]] 750 mg IV q24h''''' <br> OR <br> ▸ '''''[[Gentamicin]] 3-5 mg/kg/day divided q8h''''' <br> OR <br>  ▸ '''''[[Trimethoprim/sulfamethoxazole]] 160/800 mg PO q12h'''''
-|-
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table17" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Pseudomonas aeruginosa''}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefepime]] 2 g q12h''''' <br> OR <br> ▸ '''''[[Piperacillin]] 3 g q6h'''''<br> OR <br> ▸ '''''[[Imipenem]] 500mg q6h'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ticarcillin-clavulanate]]''''' <br> OR <br> ▸ '''''[[Tobramycin]] 3-5 mg/kg/day divided q8h''''' <br> OR <br> ▸ '''''[[Amikacin]]''''' <br> OR <br> ▸ '''''[[Ciprofloxacin]] 400 mg IV q8h'''''
-|-
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table18" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Neisseria gonorrhoeae'' }}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ceftriaxone]] 1 g IV q24h for 1-2 days after clinical improvement'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | FOLLOWED BY
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefixime]] 400 mg po q12h for 1 week'''''<BR> OR <BR> ▸ '''''[[Ciprofloxacin]] 500 mg po q12h for 1 week''''' <BR> OR <BR> ▸ '''''[[Ofloxacin]] 400 mg PO q12h for 1 week'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ciprofloxacin]] 400 mg IV q12h for 1-2 days after clinical improvement''''' <BR> OR <BR> ▸ '''''[[Ofloxacin]] 400 mg iv q12h for 1-2 days after clinical improvement''''' <BR> OR <BR> ▸ '''''[[Spectinomycin]] 2 g IM q12h for 1-2 days after clinical improvement'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | FOLLOWED BY
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ciprofloxacin]] 500 mg po q12h for 1 week''''' <BR> OR <BR> ▸ '''''[[Ofloxacin]] 400 mg po q12h for 1 week'''''
-|-
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table19" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Haemophilus influenzae'' }}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Amoxicillin-clavulanate]] 875/125 mg PO q12h''''' <br> OR <br> ▸ '''''[[Cefprozil]] 500 mg PO q12h''''' <br> OR <br> ▸ '''''[[Cefuroxime]] 500 mg PO q12h''''' <br> OR <br> ▸ '''''[[Cefdinir]] 600 mg PO q24h'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Levofloxacin]] 750 mg IV/PO q24h'''''<br> OR <br> ▸ '''''[[Moxifloxacin]] 400 mg IV/PO q24h'''''  <BR> OR <BR> ▸ '''''[[Clarithromycin]] 500 mg PO q12h'''''
-|-
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table20" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Mycobacterium tuberculosis'' }}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Intensive Phase
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Isoniazid]] 5mg/kg PO q24h for 2 months'''''<BR> OR <BR> ▸ '''''[[Isoniazid]] 10 mg/kg PO 3 times per week × 2 months'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Rifampicin]] 10 mg/kg PO q24h for 2 months''''' <BR> OR <BR> ▸ '''''[[Rifampicin]] 10 mg/kg PO 3 times per week × 2 months'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Pyrazinamide]] 25mg/kg PO q24h for 2 months'''''<BR> OR <BR> ▸ '''''[[Pyrazinamide]] 35 mg/kg PO 3 times per week × 2 months'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ethambutol]] 15mg/kg PO q24h for 2 months'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Continuation Phase
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Isoniazid]] 5mg/kg PO for 4-7 months'''''<BR> OR <BR> ▸ '''''[[Isoniazid]] 10 mg/kg PO 3 times per week × 4-7 months'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Rifampicin]] 10 mg/kg PO q24h for 4-7  months''''' <BR> OR <BR> ▸ '''''[[Rifampicin]] 10 mg/kg PO 3 times per week for 4-7  months'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | <SMALL>Adapted from ''Treatment of Tuberculosis: Guidelines.''<ref>{{Cite book  | last1 =  | first1 =  | last2 =  | first2 =  | title = Treatment of tuberculosis : guidelin | date = 2010 | publisher = World Health Organization | location = Geneva | isbn = 978-92-4-154783-3 | pages =  }}</ref></SMALL>
-|-
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table21" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Borrelia burgdorferi'' }}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Amoxicillin]] 500 mg q8h for 28 days''''' <br> OR <br>▸ '''''[[Doxycycline]] 100 mg q12h for 28 days'''''<br> OR <br>▸ '''''[[Cefuroxime]] 500 mg q12h for 28 days'''''
 |-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen
+! colspan="2" |[[Proteus vulgaris]], [[Proteus|Proteus rettgeri]], [[Morganella morganii]]
-|-
+|
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Azithromycin]] 500 mg PO q24h for 7–10 days''''' <br> OR <br> ▸ '''''[[Clarithromycin]] 500 mg PO q12h for 14–21 days''''' <br> OR <br> ▸ '''''[[Erythromycin]] 500 mg PO q6h for 14–21 days'''''
+* [[Cefotaxime]] 2 g IV  QID
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | <SMALL>Adapted from IDSA Guidelines: The Clinical Assessment, Treatment, and Prevention of Lyme Disease, Human Granulocytic Anaplasmosis, and Babesiosis: <ref>{{cite journal|doi=10.1086/522848}}</ref></SMALL>
-|-
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table22" style="background: #FFFFFF;"
+* [[Imipenem]] 500 mg IV  QID, or
-| valign=top |
+* [[Levofloxacin]] 500 mg IV/PO OD
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
+|
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Treponema pallidum'' }}
+* [[Gentamicin]] 3–5 mg/kg/day IV q6–8h, or
-|-
+* [[Ticarcillin-Clavulanate|Ticarcillin-clavulanate]] 3.1 g IV q4–6h
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Penicillin G]]  2.4 MU IM single dose'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen
 |-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Doxycycline]] 100 mg PO q12h x 14 days ''''' <BR> OR <BR> ▸ '''''[[Tetracycline]] 500 mg PO q6h x 14 days''''' <BR> OR <BR> ▸ '''''[[Ceftriaxone]] 1 g IM/IV q24h x 10 -14 days'''''
+! colspan="2" |[[Serratia marcescens]]
+|
+* [[Cefotaxime]] 2 g IV QID
+|
+* [[Levofloxacin]] 500 mg IV/PO OD
+* [[Gentamicin]] 3–5 mg/kg/day IV q6–8h
+* [[Imipenem]] 500 mg IV QID
 |-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | <SMALL> Adapted from MMWR Recomm Rep. 2006;55(RR-11):1-94<ref name="www.cdc.gov">{{Cite web  | last =  | first =  | title = http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5511a1.htm | url = http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5511a1.htm | publisher =  | date =  | accessdate = 19 May 2014 }}</ref></SMALL>
+! colspan="2" |[[Pseudomonas aeruginosa]]
-|-
+|
-|}
+* [[Cefepime]] 2 gm IV BD or
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table23" style="background: #FFFFFF;"
+* [[Piperacillin]] 3 gm IV QID or
-| valign=top |
+* [[Imipenem]] 500 IV QID
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
+|
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''T. whipplei'' }}
+* [[Ticarcillin-Clavulanate|Ticarcillin-clavulanate]] 3.1 g IV q4–6h
-|-
+* [[Tobramycin]] 3-5 mg/kg/day IV q6–8h
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
+* [[Amikacin]] 15 mg/kg/day IV/IM q8–12h
-|-
+* [[Ciprofloxacin]] 400 mg IV q8–12h
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Penicillin G]] 2 MU IV q4h for 2 weeks'''''
 |-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS
+! colspan="2" |[[Neisseria gonorrhoeae|Neisseria gonorrhea]]
-|-
+|
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Streptomycin]] 1 g IM/IV q24h for 2 weeks'''''
+* [[Ceftriaxone]] 2 g IV OD or
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | FOLLOWED BY
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Trimethoprim/Sulfamethoxazole]] 160mg/800mg PO q24h for 1 year'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ceftriaxone]] 2 g IV q24h'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | FOLLOWED BY
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Trimethoprim/Sulfamethoxazole]] 160mg/800mg PO q24h for 1 year'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | <SMALL>Adapted from N Engl J Med 2007; 356:55-66 <ref name="FenollarPuéchal2007">{{cite journal|last1=Fenollar|first1=Florence|last2=Puéchal|first2=Xavier|last3=Raoult|first3=Didier|title=Whipple's Disease|journal=New England Journal of Medicine|volume=356|issue=1|year=2007|pages=55–66|issn=0028-4793|doi=10.1056/NEJMra062477}}</ref></SMALL>
-|-
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table24" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Enterococcus spp.'' }}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin]] 2g IV q6h ''''' <br> OR <br>▸ '''''[[Vancomycin]] 1g q12h '''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin sulbactam]] 3g IV q6h ''''' <br> OR <br> ▸ '''''[[Linezolid]] 600 mg IV/PO q12h'''''
-|-
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table25" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Proteus mirabilis'' }}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin]] 2g IV q6h ''''' <br> OR <br>▸ '''''[[Levofloxacin]] 500 mg q24h '''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefazolin]] 1g IV q8 h  ''''' <br> OR <br> ▸ '''''[[TMP-SMX]] 160/800 mg PO q12h'''''
-|-
-|}
-|}
-|}
-==Pathogen-Based Therapy — Fungi==
+* [[Cefotaxime]] 1 g TID
+|
-<SMALL><font color="#FF4C4C">'''▸ Click on the following categories to expand treatment regimens.'''</font></SMALL>
+* [[Levofloxacin]] 500 mg IV/PO OD
+* [[Ampicillin]] 2 g IV QID
-{|
-| valign=top |
-<div style="border-radius: 5px 5px 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #A1BCDD; text-align: center;">
-<font color="#FFF">
-'''Fungi'''
-</font>
-</div>
-<div class="mw-customtoggle-table26" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D;border-bottom: 0px;; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Aspergillus spp.'''''
-</font>
-</div>
-<div class="mw-customtoggle-table27" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Blastomyces dermatitidis'''''
-</font>
-</div>
-<div class="mw-customtoggle-table28" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Candida spp.'''''
-</font>
-</div>
-<div class="mw-customtoggle-table29" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Coccidioides'''''
-</font>
-</div>
-<div class="mw-customtoggle-table30" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Histoplasma'''''
-</font>
-</div>
-<div class="mw-customtoggle-table31" style="cursor: pointer; border-radius: 0 0 5px 5px; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Sporothrix'''''
-</font>
-</div>
-| valign=top |
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table26" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Aspergillus spp.''<sup>†</sup>}}
 |-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
+! colspan="2" |[[Bacteroides fragilis]] group
-|-
+|
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Voriconazole]] 6 mg/kg IV q12h on day 1'''''
+* [[Clindamycin]] 900 mg IV/IM TID or
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | FOLLOWED BY
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Voriconazole]] 4 mg/kg IV q12h (goal trough: 1.0–5.5 mg/L)'''''<sup>‡</sup><BR> OR <BR> ▸ '''''[[Voriconazole]] 200 mg PO q12h (for body weight ≥40 kg)'''''<BR> OR <BR> ▸ '''''[[Voriconazole]] 100 mg PO q12h (for body weight <40 kg)'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Liposomal Amphotericin B|Liposomal amphotericin B]] 3-5 mg/kg/day IV'''''<br> OR <br> ▸ '''''[[Amphotericin B lipid complex]] 5 mg/kg/day IV'''''<br> OR <br> ▸ '''''[[Caspofungin]] 70 mg IV on day 1, then 50 mg IV q24h''''' <br> OR <br> ▸ '''''[[Micafungin]] 100 mg IV q12h (or 250 mg IV q24h)'''''<sup>¶</sup><br> OR <br> ▸ '''''[[Itraconazole]] 200 mg PO tid for 3 days, then 200 mg PO bid'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | <SMALL> <sup>†</sup> Adapted from ''Clin Infect Dis. 2008; 46:327–60.''<ref name="WalshAnaissie2008">{{cite journal|last1=Walsh|first1=Thomas J.|last2=Anaissie|first2=Elias J.|last3=Denning|first3=David W.|last4=Herbrecht|first4=Raoul|last5=Kontoyiannis|first5=Dimitrios P.|last6=Marr|first6=Kieren A.|last7=Morrison|first7=Vicki A.|last8=Segal|first8=Brahm H|last9=Steinbach|first9=William J.|last10=Stevens|first10=David A.|last11=Burik|first11=Jo‐Anne van|last12=Wingard|first12=John R.|last13=Patterson|first13=Thomas F.|title=Treatment of Aspergillosis: Clinical Practice Guidelines of the Infectious Diseases Society of America|journal=Clinical Infectious Diseases|volume=46|issue=3|year=2008|pages=327–360|issn=1058-4838|doi=10.1086/525258}}</ref>
-<sup>‡</sup> Adapted from ''Clin Infect Dis. 2012;55(8):1080-7.''<ref name="pmid22761409">{{cite journal| author=Park WB, Kim NH, Kim KH, Lee SH, Nam WS, Yoon SH et al.| title=The effect of therapeutic drug monitoring on safety and efficacy of voriconazole in invasive fungal infections: a randomized controlled trial. | journal=Clin Infect Dis | year= 2012 | volume= 55 | issue= 8 | pages= 1080-7 | pmid=22761409 | doi=10.1093/cid/cis599 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22761409  }} </ref><BR>
+* [[Metronidazole]] 500 mg TID
+|
-<sup>¶</sup> Adapted from ''J Antimicrob Chemother. 2009;64(4):840-4.''<ref name="pmid19700475">{{cite journal| author=Ikawa K, Nomura K, Morikawa N, Ikeda K, Taniwaki M| title=Assessment of micafungin regimens by pharmacokinetic-pharmacodynamic analysis: a dosing strategy for Aspergillus infections. | journal=J Antimicrob Chemother | year= 2009 | volume= 64 | issue= 4 | pages= 840-4 | pmid=19700475 | doi=10.1093/jac/dkp298 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19700475  }}</ref></SMALL>
+* [[Ampicillin-Sulbactam|Ampicillin-sulbactam]] 3 g IV QID or
-|}
+* [[Ticarcillin-Clavulanate|Ticarcillin-clavulanic acid]] 3.1 g IV QID
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table27" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Blastomyces dermatitidis''}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Moderately Severe to Severe Disease
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Liposomal Amphotericin B|Liposomal amphotericin B]] 3–5 mg/kg/day IV for 1–2 weeks'''''<BR> OR <BR> ▸ '''''[[Amphotericin B]] 0.7–1 mg/kg/day IV for 1–2 weeks'''''
 |-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | FOLLOWED BY
+! colspan="2" |[[Brucella melitensis]]
-|-
+|
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Itraconazole]] 200 mg PO tid for 3 days'''''
+* [[Doxycycline]] 100 mg PO BD and [[Streptomycin]] 15 mg/kg IM QID or
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | FOLLOWED BY
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Itraconazole]] 200 mg PO bid for ≥12 months totally'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Mild to Moderate Disease
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Itraconazole]] 200 mg PO tid for 3 days'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | FOLLOWED BY
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Itraconazole]] 200 mg PO qd–bid for 6–12 months'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | <SMALL>Adapted from ''Clin Infect Dis. 2008;46(12):1801-12.''<ref name="Chapman-2008">{{Cite journal  | last1 = Chapman | first1 = SW. | last2 = Dismukes | first2 = WE. | last3 = Proia | first3 = LA. | last4 = Bradsher | first4 = RW. | last5 = Pappas | first5 = PG. | last6 = Threlkeld | first6 = MG. | last7 = Kauffman | first7 = CA. | title = Clinical practice guidelines for the management of blastomycosis: 2008 update by the Infectious Diseases Society of America. | journal = Clin Infect Dis | volume = 46 | issue = 12 | pages = 1801-12 | month = Jun | year = 2008 | doi = 10.1086/588300 | PMID = 18462107 }}</ref></SMALL>
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table28" style="background: #FFFFFF;"
+* [[Rifampin]] 600–900 mg QID
-| valign=top |
+|
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
+* [[Doxycycline]] 100 mg PO BD and [[Gentamicin]] 5 mg/kg IV QID
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Candida spp.''}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left |  ▸ '''''[[Fluconazole]] 400mg PO q24h''''' <br> OR <br> ▸ '''''[[Liposomal Amphotericin B]] 3-5 mg/kg/day IV × for 2-3 weeks'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | FOLLOWED BY
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Fluconazole]] 400mg PO q24h to complete a total duration of therapy of 6 weeks.'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Anidulafungin]] 200-mg loading dose, then 100 mg/day × 2 weeks''''' <br> OR <br> ▸ '''''[[Caspofungin]] 70 mg IV loading dose, then 50 mg q24h × 2 weeks''''' <br> OR <br> ▸ '''''[[Micafungin]] 100 mg IV q24h × 2 weeks'''''<br> OR <br> ▸ '''''[[Amphotericin B]] deoxycholate 0.5-1 mg/kg/day IV × 2 weeks'''''
 |-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | FOLLOWED BY
+! colspan="2" |[[Haemophilus influenzae]]
+|
+* [[Amoxicillin-Clavulanate]] 875/125 mg PO BD or
+* [[Cefprozil]] 500 mg PO BD or
+* [[Cefuroxime]] 500 mg PO BD or
+* [[Cefdinir]] 600 mg PO OD
+|
+* [[Levofloxacin]] 750 mg IV/PO OD or
+* [[Moxifloxacin]] 400 mg IV/PO OD or
+* [[Clarithromycin]] 500 mg PO BD
 |-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Fluconazole]] 400mg PO q24h to complete a total duration of therapy of 6 weeks.'''''
+! colspan="2" |[[Morganella morganii]]
+|
+* [[Cefotaxime]] 2 g IV QID or
+* [[Imipenem]] 500 mg IV QID or
+* [[Levofloxacin]] 500 mg IV/PO OD
+|
+* [[Gentamicin]] 3–5 mg/kg/day IV q6–8h or
+* [[Ticarcillin-Clavulanate]] 3.1 g IV q4–6h
 |-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | <SMALL>Adapted from ''Clin Infect Dis. 2009;48(5):503-35.''<ref name="Pappas-2009">{{Cite journal  | last1 = Pappas | first1 = PG. | last2 = Kauffman | first2 = CA. | last3 = Andes | first3 = D. | last4 = Benjamin | first4 = DK. | last5 = Calandra | first5 = TF. | last6 = Edwards | first6 = JE. | last7 = Filler | first7 = SG. | last8 = Fisher | first8 = JF. | last9 = Kullberg | first9 = BJ. | title = Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. | journal = Clin Infect Dis | volume = 48 | issue = 5 | pages = 503-35 | month = Mar | year = 2009 | doi = 10.1086/596757 | PMID = 19191635 }}</ref></SMALL>
+! colspan="2" |[[Tropheryma whipplei]]
+|
+* [[Penicillin G]] 2 million units IV q4h for 2 weeks and [[Streptomycin]] 1 g IM/IV OD for 2 weeks, then [[TMP-SMX]] 160mg/800mg PO OD for 1 year
+|
+* [[Ceftriaxone]] 2 g IV OD, then [[TMP-SMX]] 160mg/800mg PO OD for 1 year
 |-
-|}
+! colspan="2" |[[Borrelia burgdorferi]]
-|}
+|
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table29" style="background: #FFFFFF;"
+* [[Amoxicillin]] 500 mg TID for 28 days or
-| valign=top |
+* [[Doxycycline]] 100 mg BD for 28 days or
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
+* [[Cefuroxime]] 500 mg BD for 28 days
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Coccidioides }}
+|
-|-
+* [[Azithromycin]] 500 mg PO OD for 7–10 days or
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
+* [[Clarithromycin]] 500 mg PO BD for 14–21 days or
-|-
+* [[Erythromycin]] 500 mg PO QID for 14–21 days
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Itraconazole]] 400-800 mg/day ''''' <br> OR <br> ▸ '''''[[Fluconazole]] 400-2000 mg/day ''''' <br> OR <br> ▸ '''''[[Ketoconazole]] 400 mg/day '''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Amphotericin B]] 0.5–1.5 mg/kg/day'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | <SMALL>Adapted from ''Clin Infect Dis. 2005;41(9):1217-23.''<ref name="Galgiani-2005">{{Cite journal  | last1 = Galgiani | first1 = JN. | last2 = Ampel | first2 = NM. | last3 = Blair | first3 = JE. | last4 = Catanzaro | first4 = A. | last5 = Johnson | first5 = RH. | last6 = Stevens | first6 = DA. | last7 = Williams | first7 = PL. | title = Coccidioidomycosis. | journal = Clin Infect Dis | volume = 41 | issue = 9 | pages = 1217-23 | month = Nov | year = 2005 | doi = 10.1086/496991 | PMID = 16206093 }}</ref></SMALL>
-|-
-|}
 |}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table30" style="background: #FFFFFF;"
+===Duration of Antimicrobial Therapy===
-| valign=top |
+{| style="border: 2px solid #696969;"
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
+! style="background: #545454; border: 0px solid #696969; padding: 0 5px; width: 300px; color: #F8F8FF;"| Clinical Setting
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|''Histoplasma capsulatum''}}
+! style="background: #545454; border: 0px solid #696969; padding: 0 5px; width: 100px; color: #F8F8FF;" | Duration
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Moderate Severe to Severe Disease
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Liposomal Amphotericin B]] 3 mg/kg/day IV × 1-2 weeks'''''   <br> OR <br> ▸ '''''[[Amphotericin B]] deoxycholate 0.7-1 mg/kg/day IV × 1-2 weeks'''''<br> OR <br> ▸ '''''[[Amphotericin B lipid complex]] 5 mg/kg/day IV × 1-2 weeks'''''
 |-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | FOLLOWED BY
+| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left | [[Staphylococcus aureus]] infection || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | 3–4 weeks
 |-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Itraconazole]] 200 mg PO q12h x 12 months'''''
+| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left | [[Streptococcus|Streptococcus groups A, B, C, G]] infection || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | 3–4 weeks
 |-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Mild to Moderate Disease
+| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left | [[Gram-negative bacilli]] infection || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | 4 weeks
 |-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Itraconazole]] 200 mg PO q12h x 12 months'''''
+| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left | [[Brucella]] infection || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | 6 weeks
 |-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | <SMALL>Adapted from ''Clin Infect Dis. 2007;45(7):807-25.''<ref name="Wheat-2007">{{Cite journal  | last1 = Wheat | first1 = LJ. | last2 = Freifeld | first2 = AG. | last3 = Kleiman | first3 = MB. | last4 = Baddley | first4 = JW. | last5 = McKinsey | first5 = DS. | last6 = Loyd | first6 = JE. | last7 = Kauffman | first7 = CA. | title = Clinical practice guidelines for the management of patients with histoplasmosis: 2007 update by the Infectious Diseases Society of America. | journal = Clin Infect Dis | volume = 45 | issue = 7 | pages = 807-25 | month = Oct | year = 2007 | doi = 10.1086/521259 | PMID = 17806045 }}</ref></SMALL>
+| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left | [[Borrelia burgdorferi]] infection || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | 30 days
 |-
-|}
+| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left | [[Mycobacterium tuberculosis]] infection || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | 9 months
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table31" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Sporothrix}}
 |-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
+| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left | [[Candida albicans]] infection || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | 6 weeks
 |-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Itraconazole]] 200 mg q12h x 12 months'''''
+| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left | Prosthetic joint infection || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | 6 weeks
 |-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen
+| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left | Post-intraarticular injection or post-arthroscopy || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | 14 days
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Liposomal Amphotericin B]] 3-5 mg/kg/day IV × for 1-2 weeks'''''   <br> OR <br> ▸ '''''[[Amphotericin B]] deoxycholate 0.7-1 mg/kg/day IV × 1-2 weeks'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | FOLLOWED BY
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Itraconazole]] 200 mg PO q12h x 12 months'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | <SMALL>Adapted from ''Clin Infect Dis. 2007; 45:1255–65<ref name="KauffmanBustamante2007">{{cite journal|last1=Kauffman|first1=C. A.|last2=Bustamante|first2=B.|last3=Chapman|first3=S. W.|last4=Pappas|first4=P. G.|title=Clinical Practice Guidelines for the Management of Sporotrichosis: 2007 Update by the Infectious Diseases Society of America|journal=Clinical Infectious Diseases|volume=45|issue=10|year=2007|pages=1255–1265|issn=1058-4838|doi=10.1086/522765}}</ref>
-</SMALL>
-|-
-|}
-|}
 |}
-==Pathogen-Based Therapy — Virus ==
+=== Prosthetic joint infection ===
+Management of prosthetic joint infection typically requires both surgical intervention and extended courses of antimicrobial therapy.  Options of surgical approach include
-The treatment for viral arthritis is symptomatic, with the use of analgesics and NSAID.  No antimicrobial therapy is recommended for treating arthritis caused by a virus.<ref name="Berner-2006">{{Cite journal  | last1 = Berner | first1 = IC. | last2 = Dudler | first2 = J. | title = [Viral arthritis]. | journal = Rev Med Suisse | volume = 2 | issue = 57 | pages = 732-4, 737 | month = Mar | year = 2006 | doi =  | PMID = 16604875 }}</ref><ref name="Märker-Hermann-2010">{{Cite journal  | last1 = Märker-Hermann | first1 = E. | last2 = Schütz | first2 = N. | last3 = Bauer | first3 = H. | title = [Viral arthritides]. | journal = Z Rheumatol | volume = 69 | issue = 10 | pages = 871-8 | month = Dec | year = 2010 | doi = 10.1007/s00393-010-0701-6 | PMID = 21128048 }}</ref> <br>
+* Debridement with retention of [[prosthesis|prosthesis:]]
-Vaccination and safe sex are the most important measures to avoid viral infections in the joint.
+** Two-stage procedure (removal of [[prosthesis]] and cement with [[debridement]] of infected tissue and placement of a joint spacer, followed by prolonged [[antibiotics]] and replacement of [[prosthesis]])
+** One-stage procedure (removal of [[prosthesis]], [[debridement]], and replacement of [[prosthesis]] in a single procedure)
-==Pathogen-Based Therapy in Patients with Prosthetic Joint <SMALL><SMALL><SMALL><SMALL><SMALL>Adapted from Diagnosis and Management of Prosthetic Joint Infection CID 2013:56<ref name="OsmonBerbari2012">{{cite journal|last1=Osmon|first1=D. R.|last2=Berbari|first2=E. F.|last3=Berendt|first3=A. R.|last4=Lew|first4=D.|last5=Zimmerli|first5=W.|last6=Steckelberg|first6=J. M.|last7=Rao|first7=N.|last8=Hanssen|first8=A.|last9=Wilson|first9=W. R.|title=Diagnosis and Management of Prosthetic Joint Infection: Clinical Practice Guidelines by the Infectious Diseases Society of America|journal=Clinical Infectious Diseases|volume=56|issue=1|year=2012|pages=e1–e25|issn=1058-4838|doi=10.1093/cid/cis803}}</ref></SMALL></SMALL></SMALL></SMALL></SMALL>==
+* Permanent resection [[arthroplasty]] and [[amputation]].
+The surgical decision should be made by orthopedic surgeon with specialty consultation, such as infectious disease or plastic surgery as necessary.<ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref>
-<SMALL><font color="#FF4C4C">'''▸ Click on the following categories to expand treatment regimens.'''</font></SMALL>
-{|
-| valign=top |
-<div style="border-radius: 5px 5px 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #A1BCDD; text-align: center;">
-<font color="#FFF">
-'''Bacteria'''
-</font>
-</div>
-<div class="mw-customtoggle-table37" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Staphylococci, oxacillin-susceptible'''''
-</font>
-</div>
-<div class="mw-customtoggle-table39" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
+Antibiotic selection and duration are determined according to the causative organisms and the surgical intervention performed.  Antimicrobial agent should achieve adequate tissue concentrations and be effective against slow-growing organisms and [[biofilms]]  in conformity with local antibiogram.  Liaison with microbiology services is recommended.  Empiric antibiotics may be required while culture results are pending and for the duration of treatment for culture-negative infection.  [[MRSA]] coverage with [[glycopeptide]] (e.g., [[Vancomycin]], [[Daptomycin]]) or [[Gram-negative]] coverage with [[Ceftriaxone]] should be considered when necessary.  Empiric or pathogen-directed antibiotic therapy is generally instituted following the procedure.<ref>{{Cite journal| issn = 1756-1833| volume = 338| pages = –1773| last1 = Matthews| first1 = Philippa C.| last2 = Berendt| first2 = Anthony R.| last3 = McNally| first3 = Martin A.| last4 = Byren| first4 = Ivor| title = Diagnosis and management of prosthetic joint infection| journal = BMJ (Clinical research ed.)| date = 2009| pmid = 19482869}}</ref>
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Staphylococci, oxacillin-resistant'''''
-</font>
-</div>
-<div class="mw-customtoggle-table40" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
+The duration of antibiotic treatment varies depending on the surgical procedure undertaken.  A six-week course of parenteral therapy is preferred if an infected [[prosthesis]] is retained, while two to four weeks of intravenous antibiotics may be sufficient if revision [[arthroplasty]] is performed.  Oral antibiotics are commonly prescribed for three to six months in the setting of retained [[prosthesis]] compared with six weeks for revision [[arthroplasty]].<ref>{{Cite journal| issn = 1756-1833| volume = 338| pages = –1773| last1 = Matthews| first1 = Philippa C.| last2 = Berendt| first2 = Anthony R.| last3 = McNally| first3 = Martin A.| last4 = Byren| first4 = Ivor| title = Diagnosis and management of prosthetic joint infection| journal = BMJ (Clinical research ed.)| date = 2009| pmid = 19482869}}</ref>
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Enterococcus spp, penicillin-susceptible'''''
-</font>
-</div>
-<div class="mw-customtoggle-table41" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Enterococcus spp, penicillin-resistant'''''
-</font>
-</div>
-<div class="mw-customtoggle-table32" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Pseudomonas aeruginosa'''''
-</font>
-</div>
-<div class="mw-customtoggle-table33" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Enterobacter spp'''''
-</font>
-</div>
-<div class="mw-customtoggle-table34" style="cursor: pointer; border-radius: 0 0 5px 5px; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Enterobacteriaceae'''''
-</font>
-</div>
-<div class="mw-customtoggle-table35" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''β-hemolytic streptococci'''''
-</font>
-</div>
-<div class="mw-customtoggle-table36" style="cursor: pointer; border-radius: 0 0 5px 5px; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Propionibacterium acnes'''''
-</font>
-</div>
-| valign=top |
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table37" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Staphylococci, oxacillin-susceptible''}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Nafcillin]] 1.5-2 g IV q4-6h'''''<br> OR <br> ▸ '''''[[Cefazolin]] 1–2 g IV q8 h''''' <br> OR <br> ▸ '''''[[Ceftriaxone]] 1–2 g IV q24h'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] IV 15 mg/kg q12h'''''<br> OR <br> ▸ '''''[[Daptomycin]] 6 mg/kg IV q24h'''''<br> OR <br> ▸ '''''[[Linezolid]] 600 mg PO/IV q12h'''
-|-
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table39" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Staphylococci, oxacillin-resistant''}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''Vancomycin 15 mg/kg IV q12h'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Daptomycin]] 6 mg/kg IV q24h'''''<br> OR <br> ▸ '''''[[Linezolid]] 600 mg PO/IV q12h'''
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table40" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Enterococcus spp, penicillin-susceptible''}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Penicillin G]] 20-40 MU IV q24h continuously or divided in 6 doses'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] IV 15 mg/kg q12h'''''<br> OR <br> ▸ '''''[[Daptomycin]] 6 mg/kg IV q24h'''''<br> OR <br> ▸ '''''[[Linezolid]] 600 mg PO/IV q12h'''
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table41" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Enterococcus spp, penicillin-resistant''}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left |▸ '''''[[Vancomycin]] IV 15 mg/kg q12h'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Daptomycin]] 6 mg/kg IV q24h'''''<br> OR <br> ▸ '''''[[Linezolid]] 600 mg PO/IV q12h'''
-|-
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table32" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Pseudomonas aeruginosa''}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefepime]] 2 g IV q12 h'''''<BR> OR <BR> ▸ '''''[[Meropenem]] 1 g IV q8 h'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left |▸ '''''[[Ciprofloxacin]] 750 mg PO q12h or 400 mg IV q12h ''''' <BR> OR <BR> ▸ '''''[[Ceftazidime]] 2 g IV q8h'''''
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table33" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Enterobacter spp''}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefepime]] 2 g IV q12h'''''<BR> OR <BR> ▸ '''''[[Ertapenem]] 1 g IV q24 h'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ciprofloxacin]] 750 mg PO q12h or 400 mg IV q12h '''''
-|-
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table34" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Enterobacteriaceae''}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''IV β-lactam based on in vitro susceptibilities''''' <BR> OR <BR> ▸ '''''[[Ciprofloxacin]] 750 mg PO q12h'''''
-|-
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table35" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''β-hemolytic streptococci''}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Penicillin G]] 20-40 MU IV q24h continuously or divided in 6 doses''''' <br> OR <br> ▸ '''''[[Ceftriaxone]] 2 g IV q24h'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 15mg/kg IV q12h '''''
-|-
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table36" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Propionibacterium acnes''}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Penicillin G]] 20-40 MU IV q24h continuously or divided in 6 doses''''' <br> OR <br> ▸ '''''[[Ceftriaxone]] 2 g IV q24h'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Clindamycin]] 600–900 mg IV q8h <br> OR <br> ▸ '''''[[Clindamycin]]300–450 mg PO q6h''''' <br> OR <br> ▸ '''''[[Vancomycin]] 15mg/kg IV q12h '''''
-|-
-|}
-|}
-|}
-<br>
 ==References==
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 [[Category:Arthritis]]
+[[Category:Disease]]
+[[Category:Emergency medicine]]
 [[Category:Medical emergencies]]
-[[Category:Signs and symptoms]]
-[[Category:Disease]]
 [[Category:Rheumatology]]
+[[Category:Infectious Disease Project]]
+[[Category:Emergency mdicine]]
+[[Category:Up-To-Date]]
 [[Category:Infectious disease]]
-[[Category:Emergency medicine]]
+[[Category:Orthopedics]]
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