Osteomyelitis medical therapy: Difference between revisions
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* First-generation cephalosporin ([[Cefadroxil]], [[Cefazolin]], [[Cephalexin]]) ≥150 mg/kg/day administered in 4 equal doses}} | * First-generation cephalosporin ([[Cefadroxil]], [[Cefazolin]], [[Cephalexin]]) ≥150 mg/kg/day administered in 4 equal doses}} | ||
{{rx|Alternative regimen| | {{rx|Alternative regimen| | ||
* Antistaphylococcal penicillin ([[Cloxacillin]], [[Flucloxacillin]], [[Dicloxacillin]], [[Nafcillin]], [[Oxacillin]]) ≤ 200 mg/kg/day administered in 4 equal doses}} | * Antistaphylococcal penicillin ([[Cloxacillin]], [[Flucloxacillin]], [[Dicloxacillin]], [[Nafcillin]], [[Oxacillin]]) ≤ 200 mg/kg/day administered in 4 equal doses}} | ||
Revision as of 17:58, 7 May 2015
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Osteomyelitis Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Osteomyelitis medical therapy On the Web |
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American Roentgen Ray Society Images of Osteomyelitis medical therapy |
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Risk calculators and risk factors for Osteomyelitis medical therapy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Treatment of osteomyelitis typically involves complete surgical debridement followed by antimicrobial therapy against suspected pathogens based on predisposing host factors and local resistance patterns. The optimal duration of therapy for chronic osteomyelitis remains uncertain. The standard recommendation for treating chronic osteomyelitis is ≥ 4–6 weeks of parenteral antibiotics. However, oral antibiotics may achieve adequate concentrations in the bone with similar cure rates as compared to parental administration, and can be considered in selected cases.
Acute Osteomyelitis in Adults – Empiric Therapy
Although osteomyelitis in adults usually has a subacute or chronic course, acute hematogenous seeding may occur in elderly patients, intravenous drug users, or patients with indwelling catheters. The most commonly isolated microorganisms are Staphylococcus aureus and Streptococcus pneumoniae. Empiric antibiotics with staphylococcal and/or streptococcal coverage should be administered based on local resistance data.
Acute Osteomyelitis in Children – Empiric Therapy
Abbreviations: OSSA, oxacillin-sensitive Staphylococcus aureus; ORSA, Oxacillin-resistant Staphylococcus aureus; CRSA, Clindamycin-resistant Staphylococcus aureus.[1]
High prevalence of OSSA in community
High prevalence of ORSA with low prevalence of CRSA in community
High prevalence of ORSA with high prevalence of CRSA in community
Chronic Osteomyelitis in Adults – Pathogen-Based Therapy
OSSA
ORSA
Penicillin-sensitive Streptococcus
Enterococcus or Streptococcus (MIC ≥ 0.5 μg/mL) or Abiotrophia or Granulicatella
Enterobacteriaceae
{{rx|Preferred regimen|
- Ceftriaxone 1–2 g IV/IM q24h for 4–6 wk OR Ertapenem 1 g IV q24h
{{rx|Alternative regimen|
- Levofloxacin 500–750 mg PO q24h OR Ciprofloxacin 500–750 mg PO q12h for 4–6 wk
Pseudomonas aeruginosa
{{rx|Preferred regimen|
Chronic Osteomyelitis in Children – Pathogen-Based Therapy
Group A beta-hemolytic Streptococcus, Haemophilus influenzae type b, and Streptococcus pneumoniae
Vertebral Osteomyelitis – Pathogen-Based Therapy
Abbreviations: OSSA, oxacillin-sensitive Staphylococcus aureus; ORSA, Oxacillin-resistant Staphylococcus aureus.[2]
OSSA or coagulase-negative staphylococci
ORSA
Streptococcus
Enterobacteriaceae, quinolone-susceptible
Enterobacteriaceae, quinolone-resistant
Pseudomonas aeruginosa
Anaerobes
- Penicillin G 5 MU IV q6h OR Ceftriaxone 2 g IV q24h (against gram-positive anaerobes) {{or2}]
- Metronidazole 500 mg PO tid (against gram-negative anaerobes)}}
References
- ↑ Peltola, Heikki; Pääkkönen, Markus (2014-01-23). "Acute osteomyelitis in children". The New England Journal of Medicine. 370 (4): 352–360. doi:10.1056/NEJMra1213956. ISSN 1533-4406. PMID 24450893.
- ↑ Zimmerli, Werner (2010-03-18). "Clinical practice. Vertebral osteomyelitis". The New England Journal of Medicine. 362 (11): 1022–1029. doi:10.1056/NEJMcp0910753. ISSN 1533-4406. PMID 20237348.