Sandbox Organ-Based Infections: Difference between revisions
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==Musculoskeletal== | ==Musculoskeletal== | ||
=== | ===Osteomyelitis=== | ||
====Candidal osteomyelitis==== | |||
{{Rx|Preferred Regimen}} | {{Rx|Preferred Regimen}} | ||
* '''[[Fluconazole]]''' 400 mg (6 mg/kg) IV/po daily {{or}} '''[[Lipid-based Amphotericin B]]''' 3-5 mg/kg daily for two weeks, followed by '''[[Fluconazole]]''' | * '''[[Fluconazole]]''' 400 mg (6 mg/kg) IV/po daily {{or}} '''[[Lipid-based Amphotericin B]]''' 3-5 mg/kg daily for two weeks, followed by '''[[Fluconazole]]''' | ||
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</li> | </li> | ||
====Chronic osteomyelitis==== | |||
{{Rx|Preferred Regimen}} | {{Rx|Preferred Regimen}} | ||
* '''[[Systemic antibiotics]]''' per culture and susceptibility results {{and}} | * '''[[Systemic antibiotics]]''' per culture and susceptibility results {{and}} | ||
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</li> | </li> | ||
====Contiguous with vascular insufficiency==== | |||
{{Rx|Preferred Regimen}} | {{Rx|Preferred Regimen}} | ||
* '''[[Systemic antibiotics]]''' per culture and susceptibility results {{and}} | * '''[[Systemic antibiotics]]''' per culture and susceptibility results {{and}} | ||
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</li> | </li> | ||
====Contiguous without vascular insufficiency==== | |||
{{Rx|Preferred Regimen}} | {{Rx|Preferred Regimen}} | ||
* '''[[Vancomycin]]''' 1 gm IV q12h {{and}} | * '''[[Vancomycin]]''' 1 gm IV q12h {{and}} | ||
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</li> | </li> | ||
====Diabetic foot==== | |||
{{Rx|Chronic Infection or Recent Antibiotic Use}} | {{Rx|Chronic Infection or Recent Antibiotic Use}} | ||
* '''[[Levofloxacin]]''' 750 mg IV/PO q24h {{or}} '''[[Cefoxitin]]''' 1 g IV q4h (or 2 g IV q6–8h) {{or}} '''[[Ceftriaxone]]''' 1–2 g/day IV/IM q12–24h {{or}} '''[[Ampicillin-Sulbactam]]''' 1.5–3 g IV/IM q6h {{or}} '''[[Moxifloxacin]]''' 400 mg IV/PO q24h {{or}} '''[[Ertapenem]]''' 1 g IV/IM q24h {{or}} '''[[Tigecycline]]''' 100 mg IV, then 50 mg IV q12h {{or}} '''[[Imipenem-Cilastatin]]''' 0.5–1 g IV q6–8h | * '''[[Levofloxacin]]''' 750 mg IV/PO q24h {{or}} '''[[Cefoxitin]]''' 1 g IV q4h (or 2 g IV q6–8h) {{or}} '''[[Ceftriaxone]]''' 1–2 g/day IV/IM q12–24h {{or}} '''[[Ampicillin-Sulbactam]]''' 1.5–3 g IV/IM q6h {{or}} '''[[Moxifloxacin]]''' 400 mg IV/PO q24h {{or}} '''[[Ertapenem]]''' 1 g IV/IM q24h {{or}} '''[[Tigecycline]]''' 100 mg IV, then 50 mg IV q12h {{or}} '''[[Imipenem-Cilastatin]]''' 0.5–1 g IV q6–8h | ||
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</li> | </li> | ||
====Foot bone==== | |||
{{Rx|Preferred Regimen}} | {{Rx|Preferred Regimen}} | ||
* '''[[Ciprofloxacin]]''' 750 mg po bid {{or}} '''[[Levofloxacin]]''' 750 mg po q24h | * '''[[Ciprofloxacin]]''' 750 mg po bid {{or}} '''[[Levofloxacin]]''' 750 mg po q24h | ||
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</li> | </li> | ||
====Foot puncture wound==== | |||
{{Rx|Preferred Regimen}} | {{Rx|Preferred Regimen}} | ||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | * '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | ||
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</li> | </li> | ||
====Hematogenous==== | |||
{{Rx|Preferred Regimen}} | {{Rx|Preferred Regimen}} | ||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | * '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | ||
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</li> | </li> | ||
====Hemoglobinopathy==== | |||
{{Rx|Preferred Regimen}} | {{Rx|Preferred Regimen}} | ||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | * '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | ||
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</li> | </li> | ||
====Prosthetic joint infection==== | |||
{{Rx|Preferred Regimen}} | {{Rx|Preferred Regimen}} | ||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | * '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | ||
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</li> | </li> | ||
====Spinal implant==== | |||
{{Rx|Preferred Regimen}} | {{Rx|Preferred Regimen}} | ||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | * '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | ||
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</li> | </li> | ||
====Staphylococcus aureus==== | |||
{{Rx|Preferred Regimen}} | {{Rx|Preferred Regimen}} | ||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | * '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | ||
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</li> | </li> | ||
====Sternal==== | |||
{{Rx|Preferred Regimen}} | {{Rx|Preferred Regimen}} | ||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | * '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | ||
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</li> | </li> | ||
===Bursitis=== | |||
{{Rx|Preferred Regimen}} | {{Rx|Preferred Regimen}} | ||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | * '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | ||
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</li> | </li> | ||
===Lyme arthritis=== | |||
{{Rx|Preferred Regimen}} | {{Rx|Preferred Regimen}} | ||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | * '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | ||
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</li> | </li> | ||
===Reactive arthritis=== | |||
{{Rx|Preferred Regimen}} | {{Rx|Preferred Regimen}} | ||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | * '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | ||
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</li> | </li> | ||
==== | ====Reiter's syndrome==== | ||
{{Rx|Preferred Regimen}} | {{Rx|Preferred Regimen}} | ||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | * '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | ||
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</li> | </li> | ||
==== | ====Post-streptococcal arthritis==== | ||
{{Rx|Preferred Regimen}} | {{Rx|Preferred Regimen}} | ||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | * '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | ||
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</li> | </li> | ||
===Septic arthritis=== | |||
{{Rx|Preferred Regimen}} | {{Rx|Preferred Regimen}} | ||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | * '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | ||
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</li> | </li> | ||
==== | ====Brucellosis==== | ||
{{Rx|Preferred Regimen}} | {{Rx|Preferred Regimen}} | ||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | * '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | ||
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</li> | </li> | ||
==== | ====Candida==== | ||
{{Rx|Preferred Regimen}} | {{Rx|Preferred Regimen}} | ||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | * '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | ||
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</li> | </li> | ||
==== | ====Gonococcal, disseminated infection==== | ||
{{Rx|Preferred Regimen}} | {{Rx|Preferred Regimen}} | ||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | * '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | ||
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</li> | </li> | ||
==== | ====Gram-negative bacilli==== | ||
{{Rx|Preferred Regimen}} | {{Rx|Preferred Regimen}} | ||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | * '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | ||
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</li> | </li> | ||
==== | ====Histoplasmosis==== | ||
{{Rx|Preferred Regimen}} | {{Rx|Preferred Regimen}} | ||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | * '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | ||
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</li> | </li> | ||
==== | ====Lyme disease==== | ||
{{Rx|Preferred Regimen}} | {{Rx|Preferred Regimen}} | ||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | * '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | ||
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</li> | </li> | ||
==== | ====Mycobacterium tuberculosis==== | ||
{{Rx|Preferred Regimen}} | {{Rx|Preferred Regimen}} | ||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | * '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | ||
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</li> | </li> | ||
==== | ====Pneumococcal==== | ||
{{Rx|Preferred Regimen}} | {{Rx|Preferred Regimen}} | ||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | * '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | ||
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</li> | </li> | ||
==== | ====Staphylococcal==== | ||
{{Rx|Preferred Regimen}} | {{Rx|Preferred Regimen}} | ||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | * '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | ||
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</li> | </li> | ||
==== | ====Streptococcal==== | ||
{{Rx|Preferred Regimen}} | {{Rx|Preferred Regimen}} | ||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | * '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | ||
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</li> | </li> | ||
==== | ====Post-intraarticular injection==== | ||
{{Rx|Preferred Regimen}} | {{Rx|Preferred Regimen}} | ||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | * '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | ||
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</li> | </li> | ||
===Gangrene=== | |||
{{Rx|Preferred Regimen}} | {{Rx|Preferred Regimen}} | ||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | * '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | ||
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</li> | </li> | ||
===Myonecrosis=== | |||
{{Rx|Preferred Regimen}} | {{Rx|Preferred Regimen}} | ||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | * '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | ||
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</li> | </li> | ||
===Necrotizing fascitis=== | |||
{{Rx|Preferred Regimen}} | {{Rx|Preferred Regimen}} | ||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | * '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | ||
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</li> | </li> | ||
==== | ====Clostridial==== | ||
{{Rx|Preferred Regimen}} | {{Rx|Preferred Regimen}} | ||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | * '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | ||
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</li> | </li> | ||
==== | ====Staphylococcal==== | ||
{{Rx|Preferred Regimen}} | {{Rx|Preferred Regimen}} | ||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | * '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | ||
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</li> | </li> | ||
==== | ====Streptococcal==== | ||
{{Rx|Preferred Regimen}} | {{Rx|Preferred Regimen}} | ||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | * '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | ||
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</li> | </li> | ||
==== | ====Synergistic==== | ||
{{Rx|Preferred Regimen}} | {{Rx|Preferred Regimen}} | ||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | * '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | ||
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</li> | </li> | ||
===Pyomyositis=== | |||
{{Rx|Preferred Regimen}} | {{Rx|Preferred Regimen}} | ||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | * '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | ||
Revision as of 04:55, 10 May 2015
Musculoskeletal
Osteomyelitis
Candidal osteomyelitis
- Fluconazole 400 mg (6 mg/kg) IV/po daily OR Lipid-based Amphotericin B 3-5 mg/kg daily for two weeks, followed by Fluconazole
- Caspofungin 70 mg loading dose, then 50 mg/day IV OR Micafungin 100 mg/day IV or Anidulafungin 200 mg IV loading dose, then 100 mg/day IV
Chronic osteomyelitis
- Systemic antibiotics per culture and susceptibility results AND
- Surgical debridement
Contiguous with vascular insufficiency
- Systemic antibiotics per culture and susceptibility results AND
- Surgical debridement AND
- Revascularization if possible
Contiguous without vascular insufficiency
- Vancomycin 1 gm IV q12h AND
- Ceftazidime 2 gm IV q8h OR Cefepime 2 gm IV q12h
- Linezolid 600 mg po/IV bid AND
- Ceftazidime 2 gm IV q8h OR Cefepime 2 gm IV q12h
- Ciprofloxacin 750 mg po bid OR Linezolid 600 mg po/IV bid
- Vancomycin 15-20 mg/kg IV q8-12h targeting trough concentrations of 15-20 mg/L
- Ciprofloxacin 750 mg po bid OR Levofloxacin 750 mg po once daily if susceptible AND
- Rifampin 300-450 mg po bid OR Rifampin 600 mg po once daily if susceptible
Diabetic foot
- Levofloxacin 750 mg IV/PO q24h OR Cefoxitin 1 g IV q4h (or 2 g IV q6–8h) OR Ceftriaxone 1–2 g/day IV/IM q12–24h OR Ampicillin-Sulbactam 1.5–3 g IV/IM q6h OR Moxifloxacin 400 mg IV/PO q24h OR Ertapenem 1 g IV/IM q24h OR Tigecycline 100 mg IV, then 50 mg IV q12h OR Imipenem-Cilastatin 0.5–1 g IV q6–8h
- Linezolid 600 mg IV/PO q12h OR Daptomycin 4 mg/kg IV q24h OR Vancomycin 15–20 mg/kg IV q8–12h (trough: 10–20 mg/L)
- Piperacillin–Tazobactam 3.375 g IV q6–8h
- (Vancomycin 15–20 mg/kg IV q8–12h OR Linezolid 600 mg IV/PO q12h OR Daptomycin 4 mg/kg IV q24h) AND
- (Piperacillin–Tazobactam 3.375 g IV q6–8h OR Imipenem-Cilastatin 0.5–1 g IV q6–8h OR Ertapenem 1 g IV/IM q24h OR Meropenem 1 g IV/IM q24h) OR (Metronidazole 15 mg/kg IV, then 7.5 mg/kg IV q6h PLUS Ceftazidime 2 g IV q8h OR Cefepime 2 g IV q8h OR Aztreonam 2 g IV q6–8h)
Foot bone
- Ciprofloxacin 750 mg po bid OR Levofloxacin 750 mg po q24h
- Ceftazidime 2 gm IV q8h OR Cefepime 2 gm IV q8h OR Meropenem 1 gm IV q8h