Sandbox ID Musculoskeletal: Difference between revisions
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===Bursitis=== | ===Bursitis=== | ||
* Olecranon bursitis or prepatellar bursitis <ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref> | |||
:*1. '''Staphylococcus aureus, methicillin-susceptible (MSSA)''' | |||
::* Preferred regimen (1): [[Nafcillin]] 2 g IV q4h | |||
::* Preferred regimen (2): [[Oxacillin]] 2 g IV q4h | |||
::* Preferred regimen (3): [[Dicloxacillin]] 500 mg PO qid | |||
:*2. '''Staphylococcus aureus, methicillin-resistant (MRSA)''' | |||
::* Preferred regimen (1): [[Vancomycin]] 1 g IV q12h | |||
::* Preferred regimen (2): [[Linezolid]] 600 mg PO qd | |||
===Osteomyelitis, candidal=== | ===Osteomyelitis, candidal=== | ||
* Osteomyelitis, candidal <ref name="pmid19191635">{{cite journal| author=Pappas PG, Kauffman CA, Andes D, Benjamin DK, Calandra TF, Edwards JE et al.| title=Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2009 | volume= 48 | issue= 5 | pages= 503-35 | pmid=19191635 | doi=10.1086/596757 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19191635 }} </ref> | |||
:* Preferred regimen (1): [[Fluconazole]] 400 mg/day (6 mg/kg/day) PO for 6–12 months | |||
:* Preferred regimen (2): [[Amphotericin B]] 3–5 mg/kg/day PO for several weeks {{then}} [[Fluconazole]] for 6–12 months | |||
:* Alternative regimen (1): [[Anidulafungin]] 200 mg loading dose {{then}} 100 mg/day PO | |||
:* Alternative regimen (2): [[Caspofungin]] 70mg loading dose {{then}} 50 mg/day PO | |||
:* Alternative regimen (3): [[Micafungin]] 100 mg/day PO | |||
:* Alternative regimen (4): [[Amphotericin B]] deoxycholate 0.5–1 mg/kg/day PO for several weeks {{then}} [[Fluconazole]] for 6–12 months | |||
:* Note: Duration of therapy usually is prolonged (6–12 months); Surgical debridement is frequently necessary | |||
===Osteomyelitis, chronic=== | ===Osteomyelitis, chronic=== | ||
*Chronic Osteomyelitis in Adults – Pathogen-Based Therapy | *1. '''Chronic Osteomyelitis in Adults – Pathogen-Based Therapy''' <ref name="pmid22157324">{{cite journal| author=Spellberg B, Lipsky BA| title=Systemic antibiotic therapy for chronic osteomyelitis in adults. | journal=Clin Infect Dis | year= 2012 | volume= 54 | issue= 3 | pages= 393-407 | pmid=22157324 | doi=10.1093/cid/cir842 | pmc=PMC3491855 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22157324 }} </ref> | ||
:*1.1 '''OSSA''' | |||
::* Preferred regimen (1): [[Oxacillin]] 1.5–2 g IV q4h for 4–6 weeks | |||
::* Preferred regimen (2): [[Cefazolin]] 1–2 g IV q8h for 4–6 weeks | |||
::* Alternative regimen (1): [[Vancomycin]] 15 mg/kg IV q12h for 4–6 weeks | |||
::* Alternative regimen (2): [[Oxacillin]] 1.5–2 g IV q4h for 4–6 weeks {{and}} [[Rifampin]] 600 mg PO qd | |||
:*1.2 '''ORSA''' | |||
::* Preferred regimen (1): [[Vancomycin]] 15 mg/kg IV q12h for 4–6 weeks | |||
::* Preferred regimen (2): [[Daptomycin]] 6 mg/kg IV q24h | |||
::* Alternative regimen (1): [[Linezolid]] 600 mg PO/IV q12h for 6 weeks {{withorwithout}} [[Rifampin]] 600–900 mg PO qd | |||
::* Alternative regimen (2): [[Levofloxacin]] 500–750 mg/day PO/IV {{withorwithout}} [[Rifampin]] 600–900 mg PO qd | |||
:*1.3 '''Penicillin-sensitive Streptococcus''' | |||
::* Preferred regimen (1): [[Penicillin G]] 20 MU/day IV continuously or q4h for 4–6 weeks | |||
::* Preferred regimen (2): [[Ceftriaxone]] 1–2 g IV/IM q24h for 4–6 weeks | |||
::* Preferred regimen (3): [[Cefazolin]] 1–2 g IV q8h for 4–6 weeks | |||
::* Alternative regimen: [[Vancomycin]] 15 mg/kg IV q12h for 4–6 weeks | |||
:*1.4 '''Enterococcus or Streptococcus (MIC≥ 0.5 μg/mL) or Abiotrophia or Granulicatella''' | |||
::* Preferred regimen (1): [[Penicillin G]] 20 MU/day IV continuously or q4h for 4–6 weeks {{withorwithout}} [[Gentamicin]] 1 mg/kg IV/IM q8h for 1–2 weeks | |||
::* Preferred regimen (2): [[Ampicillin]] 12 g/day IV continuously or q4h for 4–6 weeks {{withorwithout}} [[Gentamicin]] 1 mg/kg IV/IM q8h for 1–2 weeks | |||
::* Alternative regimen: [[Vancomycin]] 15 mg/kg IV q12h for 4–6 weeks {{withorwithout}} [[Gentamicin]] 1 mg/kg IV/IM q8h for 1–2 weeks | |||
:*1.5 '''Enterobacteriaceae''' | |||
::* Preferred regimen (1): [[Ceftriaxone]] 1–2 g IV/IM q24h for 4–6 weeks | |||
::* Preferred regimen (2): [[Ertapenem]] 1 g IV q24h | |||
::* Preferred regimen: | ::* Alternative regimen (1): [[Levofloxacin]] 500–750 mg PO qd | ||
::* Alternative regimen ( | ::* Alternative regimen (2): [[Ciprofloxacin]] 500–750 mg PO bid for 4–6 weeks | ||
::* | :*1.6 '''Pseudomonas aeruginosa''' | ||
::* Preferred regimen (1): [[Cefepime]] 2 g IV q12h | |||
::* Preferred regimen (2): [[Meropenem]] 1 g IV q8h | |||
::* Preferred | |||
::* Preferred regimen (3): [[Imipenem]] 500 mg IV q6h for 4–6 weeks | |||
::* Preferred regimen: | ::* Alternative regimen (1): [[Ciprofloxacin]] 750 mg PO q12h | ||
::* Alternative regimen | ::* Alternative regimen (2): [[Ceftazidime]] 2 g IV q8h for 4–6 weeks | ||
* Chronic Osteomyelitis in Children – Pathogen-Based Therapy | *2. '''Chronic Osteomyelitis in Children – Pathogen-Based Therapy''' | ||
:* ''Group A beta-hemolytic Streptococcus, Haemophilus influenzae type | :* ''Group A beta-hemolytic Streptococcus, Haemophilus influenzae type B and Streptococcus pneumoniae'' | ||
::* Preferred regimen: Ampicillin 150–200 mg/kg/day | ::* Preferred regimen (1): [[Ampicillin]] 150–200 mg/kg/day q6h | ||
::* Alternative regimen: Chloramphenicol 75 mg/kg/day | ::* Preferred regimen (2): [[Amoxicillin]] 150–200 mg/kg/day q6h | ||
::* Alternative regimen: [[Chloramphenicol]] 75 mg/kg/day q8h | |||
===Osteomyelitis, contiguous with | ===Osteomyelitis, contiguous with vascular insufficiency=== | ||
* Osteomyelitis, contiguous with vascular insufficiency <ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref> | |||
:* Debride overlying ulcer and send bone specimen for histology and culture. | |||
:* No empiric antimicrobial therapy unless acutely ill. | |||
:* Antibiotic therapy should be based on culture results and treat for 6 weeks. | |||
:* Revascularize if possible. | |||
===Osteomyelitis, diabetic foot=== | ===Osteomyelitis, diabetic foot=== | ||
*1. '''Chronic Infection or Recent Antibiotic Use''' <ref name="pmid23328846">{{cite journal| author=Lipsky BA, Berendt AR, Cornia PB, Pile JC, Peters EJ, Armstrong DG et al.| title=2012 infectious diseases society of america clinical practice guideline for the diagnosis and treatment of diabetic foot infections. | journal=J Am Podiatr Med Assoc | year= 2013 | volume= 103 | issue= 1 | pages= 2-7 | pmid=23328846 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23328846 }} </ref> | |||
:* Preferred regimen (1): [[Levofloxacin]] 750 mg IV/PO q24h | |||
:* Preferred regimen (2): [[Cefoxitin]] 1 g IV q4h (or 2 g IV q6–8h) | |||
:* Preferred regimen (3): [[Ceftriaxone]] 1–2 g/day IV/IM q12–24h | |||
:* Preferred regimen (4): [[Ampicillin-Sulbactam]] 1.5–3 g IV/IM q6h | |||
:* Preferred regimen (5): [[Moxifloxacin]] 400 mg IV/PO q24h | |||
:* Preferred regimen (6): [[Ertapenem]] 1 g IV/IM q24h | |||
:* Preferred regimen (7): [[Tigecycline]] 100 mg IV {{then}} 50 mg IV q12h (active against MRSA) | |||
:* Preferred regimen (8): [[Imipenem-Cilastatin]] 0.5–1 g IV q6–8h (Not active against MRSA; consider when ESBL-producing pathogens suspected) | |||
:* Alternative regimen (1): [[Levofloxacin]] 750 mg IV/PO q24h {{and}} [[Clindamycin]] 150–300 mg PO qid | |||
:* Alternative regimen (2): [[Ciprofloxacin]] 600–1200 mg/day IV q6–12h {{and}} [[Clindamycin]] 150–300 mg PO qid | |||
:* Alternative regimen (3): [[Ciprofloxacin]] 1200–2700 mg IV q6–12h (for more severe cases) {{and}} [[Clindamycin]] 150–300 mg PO qid | |||
*2. '''High Risk for MRSA''' | |||
:* Preferred regimen (1): [[Linezolid]] 600 mg IV/PO q12h | |||
:* Preferred regimen (2): [[Daptomycin]] 4 mg/kg IV q24h | |||
:* Preferred regimen (3): [[Vancomycin]] 15–20 mg/kg IV q8–12h (trough: 10–20 mg/L) | |||
*3. '''High Risk for ''Pseudomonas aeruginosa''' | |||
:* Preferred regimen: [[Piperacillin–Tazobactam]] 3.375 g IV q6–8h | |||
*4. '''Polymicrobial Infection''' | |||
:* Preferred regimen: ([[Vancomycin]] 15–20 mg/kg IV q8–12h (trough: 10–20 mg/L) {{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 q8h) | |||
:* Alternative regimen: ([[Vancomycin]] 15–20 mg/kg IV q8–12h (trough: 10–20 mg/L) {{or}} [[Linezolid]] 600 mg IV/PO q12h {{or}} [[Daptomycin]] 4 mg/kg IV q24h) {{and}} ([[Ceftazidime]] 2 g IV q8h {{or}} [[Cefepime]] 2 g IV q8h {{or}} [[Aztreonam]] 2 g IV q6–8h) {{and}} [[Metronidazole]] 15 mg/kg IV, then 7.5 mg/kg IV q6h | |||
===Osteomyelitis, foot bone=== | ===Osteomyelitis, foot bone=== | ||
* Foot bone osteomyelitis due to nail through tennis shoe <ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref> | |||
:* Preferred regimen (1): [[Ciprofloxacin]] 750 mg PO bid | |||
:* Preferred regimen (2): [[Levofloxacin]] 750 mg PO q24h | |||
:* Alternative regimen (1): [[Ceftazidime]] 2 g IV q8h | |||
:* Alternative regimen (2): [[Cefepime]] 2 g IV q12h | |||
===Osteomyelitis, foot puncture wound=== | ===Osteomyelitis, foot puncture wound=== | ||
* Long bone, post-internal fixation of fracture <ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref> | |||
:*1. '''S. aureus or P. aeruginosa''' | |||
::* Preferred regimen: [[Vancomycin]] 1 g IV q12h {{and}} ([[Ceftazidime]] {{or}} [[Cefepime]]) | |||
::* Alternative regimen (1): [[Linezolid]] 600 mg IV/PO bid<sup>NAI</sup> {{and}} [[Ceftazidime]] | |||
::* Alternative regimen (2): [[Linezolid]] 600 mg IV/PO bid<sup>NAI</sup> {{and}} [[Cefepime]] | |||
:*2. '''Gm-neg. bacilli ''' | |||
::* Preferred regimen (1): [[Ciprofloxacin]] 750 mg po bid | |||
::* Preferred regimen (2): [[Levofloxacin]] 750 mg po qd | |||
===Osteomyelitis, hematogenous=== | ===Osteomyelitis, hematogenous=== | ||
*1. '''Empiric therapy''' <ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref> | |||
:*1.1 '''Adult (>21 yrs)''' | |||
::*1.1.1 '''MRSA possible''' | |||
:::* Preferred regimen: [[Vancomycin]] 1 g IV q12h (if over 100 kg, 1.5 g IV q12h) | |||
::*1.1.2 '''MRSA unlikely''' | |||
:::* Preferred regimen: [[Nafcillin]] {{or}} [[Oxacillin]] 2 g IV q4h | |||
:*1.2 '''Children (>4 mos.)-Adult''' | |||
::*1.2.1 '''MRSA possible''' | |||
:::* Preferred regimen: [[Vancomycin]] 40 div q6–8h | |||
::*1.2.2 '''MRSA unlikely''' | |||
:::* Preferred regimen: [[Nafcillin]] {{or}} [[Oxacillin]] 37 q6h (to max. 8–12 g per day) | |||
::* Note: Add [[Ceftazidime]] 50 q8h or [[Cefepime]] 150 div q8h if Gm-neg. bacilli on Gram stain | |||
:*1.3 '''Newborn (<4 mos.)''' | |||
::*1.3.1 '''MRSA possible''' | |||
:::* Preferred regimen: [[Vancomycin]] {{and}} ([[Ceftazidime]] 2 g IV q8h or [[Cefepime]] 2 g IV q12h) | |||
::*1.3.2 '''MRSA unlikely''' | |||
:::* Preferred regimen: ([[Nafcillin]] {{or}} [[Oxacillin]]) {{and}} ([[Ceftazidime]] {{or}} [[Cefepime]]) | |||
*2. '''Specific therapy''' | |||
:*2.1 '''MSSA''' | |||
::* Preferred regimen: [[Nafcillin]] {{or}} [[Oxacillin]] 2 g IV q4h {{or}} [[Cefazolin]] 2 g IV q8h | |||
::* Alternative regimen: [[Vancomycin]] 1 g IV q12h (if over 100 kg, 1.5 g IV q12h) | |||
:*2.2 '''MRSA''' | |||
::* Preferred regimen: [[Vancomycin]] 1 g IV q12h | |||
::* Alternative regimen: [[Linezolid]] 600 mg q12h IV/po {{withorwithout}} [[Rifampin]] 300 mg po/IV bid | |||
===Osteomyelitis, hemoglobinopathy=== | ===Osteomyelitis, hemoglobinopathy=== | ||
* Osteomyelitis, hemoglobinopathy <ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref> | |||
:* Preferred regimen: [[Ciprofloxacin]] 400 mg IV q12h | |||
:* Alternative regimen: [[Levofloxacin]] 750 mg IV q24h | |||
===Osteomyelitis, spinal implant=== | |||
*1. '''Onset within 30 days''' <ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref> <ref name="pmid17342641">{{cite journal| author=Kowalski TJ, Berbari EF, Huddleston PM, Steckelberg JM, Mandrekar JN, Osmon DR| title=The management and outcome of spinal implant infections: contemporary retrospective cohort study. | journal=Clin Infect Dis | year= 2007 | volume= 44 | issue= 7 | pages= 913-20 | pmid=17342641 | doi=10.1086/512194 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17342641 }} </ref> | |||
:* Culture, treat & then suppress until fusion occurs | |||
::* Main parenteral antimicrobial therapy | |||
:::* Preferred regimen: [[Beta-lactam antibiotic]] {{or}} [[Vancomycin]] | |||
::* Suppressive antimicrobial therapy strategy | |||
:::* Preferred regimen: [[Beta-lactam antibiotic]] {{or}} [[Minocycline]] | |||
*2. '''Onset after 30 days''' | |||
:* Remove implant, culture & treat | |||
::* Main parenteral antimicrobial therapy | |||
:::* Preferred regimen: [[Beta-lactam antibiotic]] {{or}} [[Vancomycin]] {{or}} Combination therapy | |||
::* Suppressive antimicrobial therapy strategy | |||
:::* Preferred regimen: Combination therapy {{or}} [[Minocycline]] | |||
===Osteomyelitis, vertebral=== | |||
* Vertebral Osteomyelitis – Pathogen-Based Therapy <ref name="pmid2024868">{{cite journal| author=Gentry LO| title=Oral antimicrobial therapy for osteomyelitis. | journal=Ann Intern Med | year= 1991 | volume= 114 | issue= 11 | pages= 986-7 | pmid=2024868 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2024868 }} </ref> <ref name="pmid21427393">{{cite journal| author=Marschall J, Bhavan KP, Olsen MA, Fraser VJ, Wright NM, Warren DK| title=The impact of prebiopsy antibiotics on pathogen recovery in hematogenous vertebral osteomyelitis. | journal=Clin Infect Dis | year= 2011 | volume= 52 | issue= 7 | pages= 867-72 | pmid=21427393 | doi=10.1093/cid/cir062 | pmc=PMC3106232 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21427393 }} </ref> | |||
:*1. '''OSSA or coagulase-negative staphylococci''' | |||
::* Preferred regimen (1): [[Oxacillin]] 2 g IV q6h | |||
::* Preferred regimen (2): [[Cefazolin]] 1–2 g IV q8h | |||
::* Alternative regimen: [[Levofloxacin]] 750 mg PO qd {{and}} [[Rifampin]] 300 mg PO bid | |||
:*2. '''ORSA''' | |||
::* Preferred regimen: [[Vancomycin]] 1 g IV q12h | |||
::* Alternative regimen (1): [[Daptomycin]] 6 mg/kg IV q24h | |||
::* Alternative regimen (2): [[Levofloxacin]] 500–750 mg/day PO/IV {{and}} [[Rifampin]] 600–900 mg PO qd | |||
:*3. '''Streptococcus''' | |||
::* Preferred regimen: [[Penicillin G]] 5 MU IV q6h | |||
::* Alternative regimen: [[Ceftriaxone]] 2 g IV q24h | |||
:*4. '''Enterobacteriaceae, quinolone-susceptible''' | |||
::* Preferred regimen: [[Ciprofloxacin]] 750 mg PO q12h | |||
::* Alternative regimen: [[Ceftriaxone]] 2 g IV q24h | |||
:*5. '''Enterobacteriaceae, quinolone-resistant''' | |||
::* Preferred regimen: [[Imipenem]] 500 mg IV q6h | |||
:*6. '''Pseudomonas aeruginosa''' | |||
::* Preferred regimen: ([[Cefepime]] 2 g IV q8h {{or}} [[Ceftazidime]] 2 g IV q8h for 2–4 weeks), followed by [[Ciprofloxacin]] 750 mg PO bid | |||
::* Alternative regimen: [[Piperacillin–Tazobactam]] 750 mg PO q12h for 2–4 weeks, followed by [[Ciprofloxacin]] 750 mg PO bid | |||
:*7. '''Anaerobes''' | |||
::* Preferred regimen: [[Piperacillin–Tazobactam]] 750 mg PO q12h for 2–4 weeks, followed by [[Ciprofloxacin]] 750 mg PO bid | |||
::* Alternative regimen (1): [[Penicillin G]] 5 MU IV q6h | |||
::* Alternative regimen (2): [[Ceftriaxone]] 2 g IV q24h (against gram-positive anaerobes) | |||
::* Alternative regimen (3): [[Metronidazole]] 500 mg PO tid (against gram-negative anaerobes) | |||
===Osteomyelitis, sternal=== | ===Osteomyelitis, sternal=== | ||
* Osteomyelitis, sternal <ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref> | |||
:* Preferred regimen: [[Vancomycin]] 1 g IV q12h (If over 100kg, 1.5 g IV q12h) | |||
:* Alternative regimen: [[Linezolid]] 600 mg po/IV<sup>NAI</sup> bid | |||
===Osteonecrosis of the jaw=== | |||
*1. '''Bacterial Infection''' <ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref> | |||
:* Preferred regimen (1): [[Penicillin]] VK 500 mg PO q6–8h for 7–10 days (maintenance: 500 mg PO bid) | |||
:* Preferred regimen (2): [[Amoxicillin]] 500 mg PO q8h for 7–10 days (maintenance: 500 mg PO bid) | |||
:* Alternative regimen (1): [[Clindamycin]] 150–300 mg PO qid | |||
:* Alternative regimen (2): [[Doxycycline]] 100 mg PO qd | |||
:* Alternative regimen (3): [[Erythromycin]] 400 mg PO tid | |||
:* Alternative regimen (4): [[Azithromycin]] 500 mg PO single dose {{then}} 250 mg PO qd for 4 days | |||
:* Alternative regimen (5): [[Levofloxacin]] 500 mg PO qd | |||
:* Alternative regimen (6): [[Moxifloxacin]] 400 mg PO qd | |||
*2. '''Fungal Infection''' | |||
:* Preferred regimen (1): Nystatin oral suspension 5–15 mL swish qid | |||
:* Preferred regimen (2): [[Fluconazole]] 200 mg PO qd {{then}} 100 mg q24h | |||
:* Preferred regimen (3): [[Clotrimazole]] 10 mg PO tid for 7–10 days | |||
*3. '''Viral Infection''' | |||
:* Preferred regimen (1): [[Acyclovir]] 400 mg PO bid | |||
:* Preferred regimen (2): [[Valacyclovir]] 0.5–2.0 g PO bid | |||
===Reactive arthritis, post-streptococcal arthritis=== | ===Reactive arthritis, post-streptococcal arthritis=== | ||
:* | * Reactive arthritis, post-streptococcal arthritis <ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref> | ||
:* Treat strep pharyngitis and then NSAIDs ([[Prednisone]] needed in some patients) | |||
===Reactive arthritis, Reiter's syndrome=== | ===Reactive arthritis, Reiter's syndrome=== | ||
:* | * Reactive arthritis, Reiter's syndrome <ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref> | ||
:* Only treatment is non-steroidal anti-inflammatory drugs | |||
===Septic arthritis, Brucella melitensis=== | ===Septic arthritis, Brucella melitensis=== | ||
:* Preferred Regimen: Doxycycline 100 mg PO bid for ≥ 6 weeks {{and}} Streptomycin 15 mg/kg IM qd for 2–3 weeks | * Septic arthritis, Brucella melitensis <ref>{{cite book | last = Corbel | first = Michael | title = Brucellosis in humans and animals | publisher = World Health Organization | location = Geneva | year = 2006 | isbn = 9241547138 }}</ref> | ||
:* Alternative Regimen: Doxycycline 100 mg PO bid for ≥ 6 weeks {{and}} Gentamicin 5 mg/kg IV qd for 7 days | :* Preferred Regimen: [[Doxycycline]] 100 mg PO bid for ≥ 6 weeks {{and}} [[Streptomycin]] 15 mg/kg IM qd for 2–3 weeks {{or}} [[Rifampin]] 600–900 mg qd for ≥ 6 weeks | ||
:* Alternative Regimen: [[Doxycycline]] 100 mg PO bid for ≥ 6 weeks {{and}} [[Gentamicin]] 5 mg/kg IV qd for 7 days | |||
===Septic arthritis, candidal=== | ===Septic arthritis, candidal=== | ||
:* Preferred | * Septic arthritis, candidal <ref name="pmid19191635">{{cite journal| author=Pappas PG, Kauffman CA, Andes D, Benjamin DK, Calandra TF, Edwards JE et al.| title=Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2009 | volume= 48 | issue= 5 | pages= 503-35 | pmid=19191635 | doi=10.1086/596757 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19191635 }} </ref> | ||
:* Alternative | :* Preferred regimen (1): [[Fluconazole]] 400 mg/day (6 mg/kg/day) for at least 6 weeks | ||
:* | |||
:* Preferred regimen (2): [[Amphotericin B]] 3–5 mg/kg/day for several weeks {{then}} [[Fluconazole]] to completion | |||
:* Alternative regimen (1): [[Anidulafungin]] 200-mg loading dose {{then}} 100 mg/day | |||
:* Alternative regimen (2): [[Caspofungin]] 70-mg loading dose {{then}} 50 mg/day | |||
:* Alternative regimen (3): [[Micafungin]] 100 mg/day | |||
:* Alternative regimen (4): [[Amphotericin B]] deoxycholate 0.5–1 mg/kg/day for several weeks {{then}} [[Fluconazole]] to completion | |||
:* Note: Duration of therapy usually is for at least 6 weeks, but few data are available; Surgical debridement is recommended for all cases; For infected prosthetic joints, removal is recommended for most cases. | |||
===Septic arthritis, gonococcal=== | ===Septic arthritis, gonococcal=== | ||
* Septic arthritis, gonococcal <ref name="pmid12364368">{{cite journal| author=Shirtliff ME, Mader JT| title=Acute septic arthritis. | journal=Clin Microbiol Rev | year= 2002 | volume= 15 | issue= 4 | pages= 527-44 | pmid=12364368 | doi= | pmc=PMC126863 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12364368 }} </ref> | |||
:* Alternative | :* Preferred regimen: [[Ceftriaxone]] 1 g intramuscularly IM/IV q24h | ||
:* | :* Alternative regimen (1): [[Cefotaxime]] 1 g IV q8h | ||
:* Pediatric | |||
:* Alternative regimen (2): [[Ceftizoxime]] 1 g IV q8h | |||
:* Alternative regimen (3): [[Spectinomycin]] 2 g IV q12h (Penicillin allergies) | |||
:* Alternative regimen (4): [[Ciprofloxacin]] 500 mg IV q12h {{or}} [[Ofloxacin]] 400 mg IV q12h (β-lactam-allergic patient) | |||
:* Note: The tetracyclines (except in pregnant women) or penicillins may be used if the infecting organism is proven to be susceptible | |||
:* Pediatric regimen: | |||
::* >45 kg | |||
:::* Preferred regimen: [[Ceftriaxone]] 50 mg/kg (Maximum, 2 g/dose) IM/IV single dose for 10 to 14 days | |||
::* <45 kg | |||
:::* Preferred regimen: [[Ceftriaxone]] 50 mg/kg (Maximum, 1 g/dose) IM/IV single dose for 7 days | |||
===Septic arthritis, Gram-negative bacilli=== | ===Septic arthritis, Gram-negative bacilli=== | ||
:* Preferred | * Septic arthritis, Gram-negative bacilli <ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref> | ||
:* Preferred regimen (1): [[Ceftazidime]] 2 g IV q8h | |||
:* Preferred regimen (2): [[Cefepime]] 2 g IV q8–12h | |||
:* Preferred regimen (3): [[Piperacillin-Tazobactam]] 4.5 g IV q6h | |||
:* Alternative regimen (1): [[Aztreonam]] 2 g IV q8h | |||
:* Alternative | :* Alternative regimen (2): [[Imipenem]] 500 mg IV q6h | ||
:* Alternative regimen (3): [[Meropenem]] 1 g IV q8h | |||
:* Alternative regimen (4): [[Doripenem]] 500 mg IV q8h | |||
:* Alternative regimen (5): [[Carbapenems]] | |||
===Septic arthritis, Histoplasmosis=== | ===Septic arthritis, Histoplasmosis=== | ||
* Septic arthritis, histoplasmosis<ref name="pmid17806045">{{cite journal| author=Wheat LJ, Freifeld AG, Kleiman MB, Baddley JW, McKinsey DS, Loyd JE et al.| title=Clinical practice guidelines for the management of patients with histoplasmosis: 2007 update by the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2007 | volume= 45 | issue= 7 | pages= 807-25 | pmid=17806045 | doi=10.1086/521259 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17806045 }}</ref> | * Septic arthritis, histoplasmosis<ref name="pmid17806045">{{cite journal| author=Wheat LJ, Freifeld AG, Kleiman MB, Baddley JW, McKinsey DS, Loyd JE et al.| title=Clinical practice guidelines for the management of patients with histoplasmosis: 2007 update by the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2007 | volume= 45 | issue= 7 | pages= 807-25 | pmid=17806045 | doi=10.1086/521259 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17806045 }}</ref> | ||
:* Mild disease | :*1. '''Mild disease''' | ||
::* Preferred regimen: [[Nonsteroidal anti-inflammatory drug]] | ::* Preferred regimen: [[Nonsteroidal anti-inflammatory drug]] | ||
:*2. '''Severe disease''' | |||
:* Severe disease | ::* Preferred regimen: [[Prednisone]] 0.5–1.0 mg/kg/day (Maximum, 80 mg/day) in tapering doses over 1–2 weeks {{and}} [[Itraconazole]] 200 mg tid for 3 days, followed by qd or bid for 6–12 weeks | ||
::* Preferred regimen: [[Prednisone]] 0.5–1.0 mg/kg/day ( | |||
===Septic arthritis, Lyme disease=== | ===Septic arthritis, Lyme disease=== | ||
* Septic arthritis, Lyme disease <ref name="pmid17029130">{{cite journal| author=Wormser GP, Dattwyler RJ, Shapiro ED, Halperin JJ, Steere AC, Klempner MS et al.| title=The clinical assessment, treatment, and prevention of lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2006 | volume= 43 | issue= 9 | pages= 1089-134 | pmid=17029130 | doi=10.1086/508667 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17029130 }} </ref> | * Septic arthritis, Lyme disease <ref name="pmid17029130">{{cite journal| author=Wormser GP, Dattwyler RJ, Shapiro ED, Halperin JJ, Steere AC, Klempner MS et al.| title=The clinical assessment, treatment, and prevention of lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2006 | volume= 43 | issue= 9 | pages= 1089-134 | pmid=17029130 | doi=10.1086/508667 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17029130 }} </ref> | ||
:* Patients without clinical evidence of neurologic disease | :*1. '''Patients without clinical evidence of neurologic disease''' | ||
::* Preferred | ::* Preferred regimen (1): [[Doxycycline]] 100 mg bid for 28 days | ||
::* Preferred regimen (2): [[Amoxicillin]] 500 mg tid for 28 days | |||
* | ::* Preferred regimen (3): [[Cefuroxime axetil]] 500 mg bid for 28 days | ||
::* Pediatric regimen (1): [[Amoxicillin]] 50 mg/kg/day tid (Maximum, 500 mg/dose) | |||
::* Pediatric regimen (2): [[Cefuroxime axetil]] 30 mg/kg/day bid (Maximum, 500 mg/dose) | |||
::* | |||
::* ''' | ::* Pediatric regimen (3): (if the patient is ≥8 years of age) [[Doxycycline]] 4 mg/kg/day bid (Maximum, 100 mg/dose) | ||
:::* | :*2. '''Patients with arthritis and objective evidence of neurologic disease''' | ||
::* Preferred regimen: [[Ceftriaxone]] administered parenterally for 2–4 weeks | |||
::* Alternative regimen: [[Cefotaxime]] {{or}} [[Penicillin G]] administered parenterally | |||
::* Pediatric regimen: [[Ceftriaxone]] {{or}} [[Cefotaxime]] {{or}} [[Penicillin G]] administered intravenously | |||
:* Note (1): For patients who have persistent or recurrent joint swelling after a recommended course of oral antibiotic therapy, we recommend re-treatment with another 4-week course of oral antibiotics or with a 2–4-week course of [[Ceftriaxone]] IV | |||
:* Note (2): If patients have no resolution of arthritis despite intravenous therapy and if PCR results for a sample of synovial fluid (and synovial tissue if available) are negative, symptomatic treatment is recommended, which consist of nonsteroidal anti-inflammatory agents, intra-articular injections of corticosteroids, or disease-modifying antirheumatic drugs (DMARDs), such as Hydroxychloroquine. | |||
===Septic arthritis, Mycobacterium tuberculosis=== | |||
::* '''Continuation phase ( | * Septic arthritis, Mycobacterium tuberculosis<ref>{{Cite book| edition = 4th| publisher = World Health Organization| isbn = 9789241547833| title = Treatment of Tuberculosis: Guidelines| location = Geneva| series = WHO Guidelines Approved by the Guidelines Review Committee| accessdate = 2015-06-08| date = 2010| url = http://www.ncbi.nlm.nih.gov/books/NBK138748/| pmid = 23741786}}</ref> | ||
:::* Preferred regimen: [[Isoniazid]] 10–15 mg/kg (max: 300 mg) for 7 months {{and}} [[Rifampin]] 10–20 mg/kg (max: 600 mg) for 7 months | :*1. '''Septic arthritis caused by susceptible Mycobacterium tuberculosis''' | ||
::*1.1 '''Adults''' | |||
:* Specific considerations | :::*1.1.1 '''Intensive phase''' | ||
::* '''Pregnancy and breastfeeding''' | ::::* Preferred regimen: [[Isoniazid]] 5 mg/kg (max, 300 mg) for 2 months {{and}} [[Rifampin]] 10 mg/kg (max: 600 mg) for 2 months {{and}} [[Pyrazinamide]] 15–30 mg/kg (max: 2 g) for 2 months {{and}} [[Ethambutol]] 15–20 mg/kg (max: 1 g) for 2 months | ||
:::* With the exception of streptomycin, the first line anti-TB drugs are safe for use in pregnancy: | :::*1.1.2 '''Continuation phase''' | ||
::::* Preferred regimen: [[Isoniazid]] 5 mg/kg (max: 300 mg) for 7 months {{and}} [[Rifampin]] 10 mg/kg (max: 600 mg) for 7 months | |||
::*1.2 '''Pediatric''' | |||
:::*1.2.1 '''Intensive phase''' | |||
::::* Preferred regimen: [[Isoniazid]] 10–15 mg/kg (max: 300 mg) for 2 months {{and}} [[Rifampin]] 10–20 mg/kg (max: 600 mg) for 2 months {{and}} [[Pyrazinamide]] 15–30 mg/kg (max: 2 g) for 2 months {{and}} [[Ethambutol]] 15–20 mg/kg (max: 1 g) for 2 months | |||
:::*1.2.2 '''Continuation phase''' | |||
::::* Preferred regimen: [[Isoniazid]] 10–15 mg/kg (max: 300 mg) for 7 months {{and}} [[Rifampin]] 10–20 mg/kg (max: 600 mg) for 7 months | |||
:*2. '''Specific considerations''' | |||
::*2.1 '''Pregnancy and breastfeeding''' | |||
:::* With the exception of streptomycin, the first line anti-TB drugs are safe for use in pregnancy: [[Streptomycin]] is ototoxic to the fetus and should not be used during pregnancy. | |||
:::* After active TB in the baby is ruled out, the baby should be given 6 months of isoniazid preventive therapy, followed by BCG vaccination. | :::* After active TB in the baby is ruled out, the baby should be given 6 months of isoniazid preventive therapy, followed by BCG vaccination. | ||
:::* Pyridoxine supplementation is recommended for all pregnant or breastfeeding women taking isoniazid. | :::* Pyridoxine supplementation is recommended for all pregnant or breastfeeding women taking isoniazid. | ||
::*2.2 '''Liver disorders''' | |||
::* '''Liver disorders''' | |||
:::* Two hepatotoxic drugs (rather than the three in the standard regimen): | :::* Two hepatotoxic drugs (rather than the three in the standard regimen): | ||
::::* 9 months of | ::::* 9 months of [[Isoniazid]] {{and}} [[Rifampicin]] {{and}} [[Ethambutol]] (until or unless [[Isoniazid]] susceptibility is documented). | ||
::::* 2 months of | ::::* 2 months of [[Isoniazid]] {{and}} [[Rifampicin]] {{and}} [[Streptomycin]] {{and}} [[Ethambutol]], followed by 6 months of [[Isoniazid]] {{and}} [[Rifampicin]]. | ||
::::* 6–9 months of | ::::* 6–9 months of [[Rifampicin]] {{and}} [[Pyrazinamide]] {{and}} [[Ethambutol]] | ||
:::* One hepatotoxic drug: | :::* One hepatotoxic drug: | ||
::::* 2 months of | ::::* 2 months of [[Isoniazid]] {{and}} [[Ethambutol]] {{and}} [[Streptomycin]], followed by 10 months of [[Isoniazid]] {{and}} [[Ethambutol]] | ||
:::* No hepatotoxic drugs: | :::* No hepatotoxic drugs: | ||
::::* 18–24 months of | ::::* 18–24 months of [[Streptomycin]] {{and}} [[Ethambutol]] {{and}} a [[Fluoroquinolone]] | ||
::*2.3 '''Renal failure and severe renal insufficiency''' | |||
::* '''Renal failure and severe renal insufficiency''' | |||
:::* The recommended initial TB treatment regimen for patients with renal failure or severe renal insufficiency is 2 months of isoniazid, rifampicin, pyrazinamide and ethambutol, followed by 4 months of isoniazid and rifampicin. | :::* The recommended initial TB treatment regimen for patients with renal failure or severe renal insufficiency is 2 months of isoniazid, rifampicin, pyrazinamide and ethambutol, followed by 4 months of isoniazid and rifampicin. | ||
:::* There is significant renal excretion of ethambutol and metabolites of pyrazinamide, and doses should therefore be adjusted. | :::* There is significant renal excretion of ethambutol and metabolites of pyrazinamide, and doses should therefore be adjusted. | ||
:::* Three times per week administration of these two drugs at the following doses is recommended: pyrazinamide (25 mg/kg), and ethambutol (15 mg/kg) | :::* Three times per week administration of these two drugs at the following doses is recommended: pyrazinamide (25 mg/kg), and ethambutol (15 mg/kg) | ||
:::* While receiving isoniazid, patients with severe renal insufficiency or failure should also be given pyridoxine in order to prevent peripheral neuropathy. | :::* While receiving isoniazid, patients with severe renal insufficiency or failure should also be given pyridoxine in order to prevent peripheral neuropathy. | ||
:::* Because of an increased risk of nephrotoxicity and ototoxicity, | :::* Because of an increased risk of nephrotoxicity and ototoxicity, [[Streptomycin]] should be avoided in patients with renal failure. If [[Streptomycin]] must be used, the dosage is 15 mg/kg, two or three times per week, to a maximum of 1 gram per dose, and serum levels of the drug should be monitored. | ||
::*2.4 '''Previously treated patients in settings with rapid DST''' | |||
::* '''Previously treated patients in settings with rapid DST''' | |||
:::* TB patients whose treatment has failed or other patient groups with high likelihood of multidrug-resistant TB (MDR) should be started on an empirical MDR regimen. | :::* TB patients whose treatment has failed or other patient groups with high likelihood of multidrug-resistant TB (MDR) should be started on an empirical MDR regimen. | ||
:::* TB patients returning after defaulting or relapsing from their first treatment course may receive the retreatment regimen containing first-line drugs 2HRZES/1HRZE/5HRE if country-specific data show low or medium levels of MDR in these patients or if such data are not available. | :::* TB patients returning after defaulting or relapsing from their first treatment course may receive the retreatment regimen containing first-line drugs 2HRZES/1HRZE/5HRE if country-specific data show low or medium levels of MDR in these patients or if such data are not available. | ||
::*2.5 '''TB treatment in people living with HIV''' | |||
::* '''TB treatment in people living with HIV''' | |||
:::* TB patients with known positive HIV status and all TB patients living in HIV prevalent settings should receive daily TB treatment at least during the intensive phase. | :::* TB patients with known positive HIV status and all TB patients living in HIV prevalent settings should receive daily TB treatment at least during the intensive phase. | ||
:::* For the continuation phase, the optimal dosing frequency is also daily for these patients. | :::* For the continuation phase, the optimal dosing frequency is also daily for these patients. | ||
Line 159: | Line 376: | ||
===Septic arthritis, post-intraarticular injection=== | ===Septic arthritis, post-intraarticular injection=== | ||
* NO empiric therapy. | * Septic arthritis, post-intraarticular injection <ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref> | ||
:* NO empiric therapy. | |||
===Septic arthritis, prosthetic joint infection=== | ===Septic arthritis, prosthetic joint infection=== | ||
* Septic arthritis, prosthetic joint infection (device-related osteoarticular infections) | * Septic arthritis, prosthetic joint infection (device-related osteoarticular infections) <ref name="pmid23230301">{{cite journal| author=Osmon DR, Berbari EF, Berendt AR, Lew D, Zimmerli W, Steckelberg JM et al.| title=Executive summary: diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2013 | volume= 56 | issue= 1 | pages= 1-10 | pmid=23230301 | doi=10.1093/cid/cis966 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23230301 }} </ref> | ||
:* Empiric antimicrobial therapy | :*1. '''Empiric antimicrobial therapy''' | ||
::* It is preferable to delay antibiotic therapy until specimens for culture are obtained by joint aspiration, joint debridement, and/or prosthesis removal. | ::* It is preferable to delay antibiotic therapy until specimens for culture are obtained by joint aspiration, joint debridement, and/or prosthesis removal. | ||
:*2. '''Pathogen-directed antimicrobial therapy''' | |||
::*2.1 '''Staphylococcus aureus, methicillin-susceptible (MSSA)''' | |||
:::* Preferred regimen (1): [[Nafcillin]] 2 g IV q4–6h | |||
: | :::* Preferred regimen (2): [[Oxacillin]] 2 g IV q4–6h | ||
::* | :::* Alternative regimen (1): [[Cefazolin]] 1–2 g IV q8h | ||
:::* Alternative regimen: | :::* Alternative regimen (2): [[Ceftriaxone]] 2 g IV q24h | ||
:::* Alternative regimen (if allergic to penicillins) | :::* Alternative regimen (3): (if allergic to penicillins) [[Clindamycin]] 900 mg IV q8h | ||
::* Staphylococcus, methicillin-resistant (MRSA) | :::* Alternative regimen (4): (if allergic to penicillins) [[Vancomycin]] 15–20 mg/kg IV q8–12h (Maximum, 2 g/dose) | ||
:::* Early-onset | ::*2.2 '''Staphylococcus, methicillin-resistant (MRSA)''' | ||
:::*2.2.1 '''Early-onset or acute hematogenous prosthetic joint infections involving a stable implant with short duration (< 3 weeks) of symptoms and debridement (but device retention)''' | |||
::::* Preferred regimen: [[Vancomycin]] {{and}} [[Rifampin]] 600 mg PO qd or 300–450 mg PO bid for 2 weeks | ::::* Preferred regimen: [[Vancomycin]] {{and}} [[Rifampin]] 600 mg PO qd or 300–450 mg PO bid for 2 weeks | ||
::::* Alternative regimen: ([[Daptomycin]] 6 mg/kg IV q24h {{or}} [[Linezolid]] 600 IV q8h) {{and}} [[Rifampin]] 600 mg PO qd or 300–450 mg PO bid for 2 weeks | ::::* Alternative regimen: ([[Daptomycin]] 6 mg/kg IV q24h {{or}} [[Linezolid]] 600 IV q8h) {{and}} [[Rifampin]] 600 mg PO qd or 300–450 mg PO bid for 2 weeks | ||
:::: | ::::* Note: The above regimen should be followed by [[Rifampin]] plus a fluoroquinolone, TMP/SMX, a tetracycline or [[Clindamycin]] for 3 or 6 months for hips and knees, respectively. | ||
:::*2.2.2 '''Early-onset spinal implant infections or implants in an actively infected site''' | |||
:::* Early-onset spinal implant infections | ::::* Initial parenteral therapy plus [[Rifampin]] followed by prolonged oral therapy is recommended. | ||
::::* Initial parenteral therapy plus | ::::* Long-term oral suppressive antibiotics (eg, TMP-SMX, a tetracycline, a fluoroquinolone [which should be given in conjunction with [[Rifampin]] due to the potential emergence of fluoroquinolone resistance) | ||
::::* Long-term oral suppressive antibiotics (eg, TMP-SMX, a tetracycline, a fluoroquinolone [which should be given in conjunction with | ::*2.3 '''Streptococci, beta-hemolytic''' | ||
:::* Preferred regimen (1): [[Penicillin]] 12–18 MU/day IV q6h | |||
::* Streptococci, beta-hemolytic | |||
:::* Preferred regimen: [[Penicillin]] 12–18 MU/day IV q6h | |||
:::* Preferred regimen (2): [[Ampicillin]] 2 g IV q6h | |||
:::* Combination therapy (one of the monotherapy agents, and one of the following agents) | :::* Preferred regimen (3): [[Ceftriaxone]] 1–2 g IV q24h | ||
:::* Alternative regimen (1): (if allergic to penicillins) [[Clindamycin]] 900 mg IV q8h | |||
:::* Alternative regimen (2): (if allergic to penicillins) [[Vancomycin]] 15–20 mg/kg IV q8–12h (Maximum, 2 g/dose) | |||
::*2.4 '''Enterococci''' | |||
:::*2.4.1 '''Monotherapy''' | |||
::::* Preferred regimen (1): [[Ampicillin]] 6-12 g/day q4-6h | |||
::::* Preferred regimen (2): [[Penicillin G]] 18-30 MU/day continuously or q4h | |||
::::* Preferred regimen (3): [[Vancomycin]] 15-20 mg/kg/dose q8-12h (Maximum, 2 g/dose) | |||
:::*2.4.2 '''Combination therapy (one of the monotherapy agents, and one of the following agents)''' | |||
::::* Preferred regimen (1): [[Gentamicin]] 1 mg/kg IV q8h | ::::* Preferred regimen (1): [[Gentamicin]] 1 mg/kg IV q8h | ||
::::* Preferred regimen (2): [[Streptomycin]] 7.5 mg/kg IV q12h | ::::* Preferred regimen (2): [[Streptomycin]] 7.5 mg/kg IV q12h | ||
::::* Preferred regimen (3): [[Ampicillin]] 2 g/day IV q6h {{and}} [[Ceftriaxone]] 2 g IV q12h | ::::* Preferred regimen (3): [[Ampicillin]] 2 g/day IV q6h {{and}} [[Ceftriaxone]] 2 g IV q12h | ||
::*2.5 '''Gram-negative bacilli''' | |||
::* Gram-negative bacilli | |||
:::* Patients susceptible to fluoroquinolones | :::* Patients susceptible to fluoroquinolones | ||
::::* Preferred regimen: Ciprofloxacin 500 | ::::* Preferred regimen: [[Ciprofloxacin]] 500-750 mg bid | ||
:::* ''P. aeruginosa'' | :::*2.5.1 '''P. aeruginosa''' | ||
::::* Preferred | ::::* Preferred regimen (1): [[Cefepime]] 2 g IV q12h | ||
::* | ::::* Preferred regimen (2): [[Meropenem]] 1 g IV q8h | ||
:: | ::::* Alternative regimen (1): [[Ciprofloxacin]] 750 mg PO bid | ||
:::* | ::::* Alternative regimen (2): [[Ceftazidime]] 2 g IV q8h | ||
::*2.6 '''Anaerobes''' | |||
:: | :::*2.6.1'''Propionibacterium acnes''' | ||
:::* Preferred regimen: | ::::* Preferred regimen (1): [[Penicillin]] 24 MU/day IV q4h or continuously | ||
::* Mycobacterium tuberculosis | ::::* Preferred regimen (2): [[Ceftriaxone]] 1-2 g/day IV | ||
::::* Alternative regimen: [[Vancomycin]] {{or}} [[Clindamycin]] | |||
:::*2.6.2 '''Not Propionibacterium acnes''' | |||
:::* Preferred regimen: [[Metronidazole]] 500 mg PO tid | |||
::*2.7 '''Mycobacterium tuberculosis''' | |||
:::* Preferred regimen: see (Septic arthritis, Mycobacterium tuberculosis) | :::* Preferred regimen: see (Septic arthritis, Mycobacterium tuberculosis) | ||
::*2.8 '''Fungi''' | |||
::* Fungi | |||
:::* Preferred regimen: see (Septic arthritis, candidal) | :::* Preferred regimen: see (Septic arthritis, candidal) | ||
::*2.9 '''Culture negative''' | |||
::* Culture negative | :::* Preferred regimen: [[Vancomycin]] {{and}} [[Ciprofloxacin]] {{or}} [[Cefazolin]] {{and}} [[Ciprofloxacin]] | ||
:::* Preferred regimen: | |||
===Septic arthritis, staphylococcal=== | ===Septic arthritis, staphylococcal=== | ||
''Staphylococcus aureus (methicillin-resistant)'' | *1.'''Staphylococcus aureus (methicillin-resistant)'''<ref name="pmid21208910">{{cite journal| author=Liu C, Bayer A, Cosgrove SE, Daum RS, Fridkin SK, Gorwitz RJ et al.| 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=Clin Infect Dis | year= 2011 | volume= 52 | issue= 3 | pages= e18-55 | pmid=21208910 | doi=10.1093/cid/ciq146 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21208910 }} </ref><ref name="pmid23591823">{{cite journal| author=Sharff KA, Richards EP, Townes JM| title=Clinical management of septic arthritis. | journal=Curr Rheumatol Rep | year= 2013 | volume= 15 | issue= 6 | pages= 332 | pmid=23591823 | doi=10.1007/s11926-013-0332-4 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23591823 }} </ref><ref name=name of the journal>{{cite web | title = topic name and journal name| url =http://www.uptodate.com/contents/septic-arthritis-in-adults?source=search_result&search=Septic+arthritis&selectedTitle=1~150#H18 }}</ref> | ||
:* Preferred regime: Vancomycin 15–20 mg/kg IV q8–12h | :* Preferred regime: [[Vancomycin]] 15–20 mg/kg IV q8–12h | ||
:* Alternative regimen (1): [[Daptomycin]] 6 mg/kg IV q24h | |||
:* Alternative regimen (2): [[Linezolid]] 600 mg PO/IV q12h | |||
:* Alternative regimen (3): [[Clindamycin]] 600 mg PO/IV q8h | |||
:* Alternative regimen (4): [[TMP-SMX]] 3.5–4.0 mg/kg PO/IV q8–12h | |||
:* Pediatric regimen(1): [[Vancomycin]] 15 mg/kg IV q6h | |||
:* Pediatric regimen(1): [[Daptomycin]] 6–10 mg/kg IV q24h | |||
:* Pediatric regimen(1): [[Linezolid]] 10 mg/kg PO/IV q8h | |||
:* Pediatric regimen(1): [[Clindamycin]] 10–13 mg/kg/dose PO/IV q6–8h | |||
2. '''Staphylococcus aureus (methicillin-susceptible)''' | |||
:* Preferred regimen (1): [[Nafcillin]] 2 g IV q6h | |||
:* | :* Preferred regimen (2): [[Clindamycin]] 900 mg IV q8h | ||
:* Alternative regimen (1): [[Cefazolin]] 0.25–1 g IV/IM q6–8h | |||
:* Alternative regimen (2): [[Vancomycin]] 500 mg IV q6h or 1 g IV q12h | |||
3. '''Staphylococcus epidermidis (methicillin-resistant)''' | |||
:* Alternative regimen ( | :* Preferred regimen (1): [[Vancomycin]] 500 mg IV q6h or 1 g IV q12h | ||
:* Preferred regimen (2): [[Linezolid]] 600 mg IV q12h | |||
:* Alternative regimen: (TMP-SMX 3.5–4.0 mg/kg PO/IV q8–12h (TMP component) {{or}} [[Minocycline]] 200 mg PO single dose {{then}} 100 mg PO q12h) {{and}} [[Rifampin]] 300–600 mg PO/IV q12h | |||
4. '''Staphylococcus epidermidis (methicillin-susceptible)''' | |||
:* Preferred regimen (1): [[Nafcillin]] 2 g IV q6h | |||
:* | :* Preferred regimen (2): [[Clindamycin]] 900 mg IV q8h | ||
:* Alternative regimen (1): [[Cefazolin]] 0.25–1 g IV/IM q6–8h | |||
:* Alternative regimen (2): [[Vancomycin]] 500 mg IV q6h or 1 g IV q12h | |||
''Staphylococcus epidermidis (methicillin-resistant)'' | |||
:* Preferred | |||
:* Alternative | |||
''Staphylococcus epidermidis (methicillin-susceptible)'' | |||
:* Preferred | |||
:* Alternative | |||
===Septic arthritis, streptococcal=== | ===Septic arthritis, streptococcal=== | ||
''Streptococcus agalactiae'' | 1. '''Streptococcus agalactiae''' <ref>{{cite web | title = Clinical Management of Septic Arthritis| url =http://www.med.unc.edu/tarc/events/event-files/septic%20arthritis%20management.pdf }}</ref> | ||
:* Preferred | :* Preferred regimen (1): [[Penicillin G]] 2 MU IV/IM q4h | ||
:* Preferred regimen (2): [[Ampicillin]] 2 g IV q6h | |||
:* Alternative | :* Alternative regimen (1): [[Clindamycin]] 600–1200 mg/day IV/IM q6–12h | ||
''Streptococcus pyogenes'' | :* Alternative regimen (2): [[Cefazolin]] 0.25–1 g IV/IM q6–8h | ||
:* Preferred | 2. '''Streptococcus pyogenes''' | ||
:* Preferred regimen (1): [[Penicillin G]] 2 MU IV/IM q4h | |||
:* Alternative | :* Preferred regimen (2): [[Ampicillin]] 2 g IV q6h | ||
:* Alternative regimen (1): [[Clindamycin]] 600–1200 mg/day IV/IM q6–12h | |||
:* Alternative regimen (2): [[Cefazolin]] 0.25–1 g IV/IM q6–8h | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} |
Latest revision as of 14:46, 31 July 2015
Bursitis
- Olecranon bursitis or prepatellar bursitis [1]
- 1. Staphylococcus aureus, methicillin-susceptible (MSSA)
- Preferred regimen (1): Nafcillin 2 g IV q4h
- Preferred regimen (2): Oxacillin 2 g IV q4h
- Preferred regimen (3): Dicloxacillin 500 mg PO qid
- 2. Staphylococcus aureus, methicillin-resistant (MRSA)
- Preferred regimen (1): Vancomycin 1 g IV q12h
- Preferred regimen (2): Linezolid 600 mg PO qd
Osteomyelitis, candidal
- Osteomyelitis, candidal [2]
- Preferred regimen (1): Fluconazole 400 mg/day (6 mg/kg/day) PO for 6–12 months
- Preferred regimen (2): Amphotericin B 3–5 mg/kg/day PO for several weeks THEN Fluconazole for 6–12 months
- Alternative regimen (1): Anidulafungin 200 mg loading dose THEN 100 mg/day PO
- Alternative regimen (2): Caspofungin 70mg loading dose THEN 50 mg/day PO
- Alternative regimen (3): Micafungin 100 mg/day PO
- Alternative regimen (4): Amphotericin B deoxycholate 0.5–1 mg/kg/day PO for several weeks THEN Fluconazole for 6–12 months
- Note: Duration of therapy usually is prolonged (6–12 months); Surgical debridement is frequently necessary
Osteomyelitis, chronic
- 1. Chronic Osteomyelitis in Adults – Pathogen-Based Therapy [3]
- 1.1 OSSA
- Preferred regimen (1): Oxacillin 1.5–2 g IV q4h for 4–6 weeks
- Preferred regimen (2): Cefazolin 1–2 g IV q8h for 4–6 weeks
- Alternative regimen (1): Vancomycin 15 mg/kg IV q12h for 4–6 weeks
- Alternative regimen (2): Oxacillin 1.5–2 g IV q4h for 4–6 weeks AND Rifampin 600 mg PO qd
- 1.2 ORSA
- Preferred regimen (1): Vancomycin 15 mg/kg IV q12h for 4–6 weeks
- Preferred regimen (2): Daptomycin 6 mg/kg IV q24h
- Alternative regimen (1): Linezolid 600 mg PO/IV q12h for 6 weeks ± Rifampin 600–900 mg PO qd
- Alternative regimen (2): Levofloxacin 500–750 mg/day PO/IV ± Rifampin 600–900 mg PO qd
- 1.3 Penicillin-sensitive Streptococcus
- Preferred regimen (1): Penicillin G 20 MU/day IV continuously or q4h for 4–6 weeks
- Preferred regimen (2): Ceftriaxone 1–2 g IV/IM q24h for 4–6 weeks
- Preferred regimen (3): Cefazolin 1–2 g IV q8h for 4–6 weeks
- Alternative regimen: Vancomycin 15 mg/kg IV q12h for 4–6 weeks
- 1.4 Enterococcus or Streptococcus (MIC≥ 0.5 μg/mL) or Abiotrophia or Granulicatella
- Preferred regimen (1): Penicillin G 20 MU/day IV continuously or q4h for 4–6 weeks ± Gentamicin 1 mg/kg IV/IM q8h for 1–2 weeks
- Preferred regimen (2): Ampicillin 12 g/day IV continuously or q4h for 4–6 weeks ± Gentamicin 1 mg/kg IV/IM q8h for 1–2 weeks
- Alternative regimen: Vancomycin 15 mg/kg IV q12h for 4–6 weeks ± Gentamicin 1 mg/kg IV/IM q8h for 1–2 weeks
- 1.5 Enterobacteriaceae
- Preferred regimen (1): Ceftriaxone 1–2 g IV/IM q24h for 4–6 weeks
- Preferred regimen (2): Ertapenem 1 g IV q24h
- Alternative regimen (1): Levofloxacin 500–750 mg PO qd
- Alternative regimen (2): Ciprofloxacin 500–750 mg PO bid for 4–6 weeks
- 1.6 Pseudomonas aeruginosa
- Preferred regimen (1): Cefepime 2 g IV q12h
- Preferred regimen (2): Meropenem 1 g IV q8h
- Preferred regimen (3): Imipenem 500 mg IV q6h for 4–6 weeks
- Alternative regimen (1): Ciprofloxacin 750 mg PO q12h
- Alternative regimen (2): Ceftazidime 2 g IV q8h for 4–6 weeks
- 2. Chronic Osteomyelitis in Children – Pathogen-Based Therapy
- Group A beta-hemolytic Streptococcus, Haemophilus influenzae type B and Streptococcus pneumoniae
- Preferred regimen (1): Ampicillin 150–200 mg/kg/day q6h
- Preferred regimen (2): Amoxicillin 150–200 mg/kg/day q6h
- Alternative regimen: Chloramphenicol 75 mg/kg/day q8h
Osteomyelitis, contiguous with vascular insufficiency
- Osteomyelitis, contiguous with vascular insufficiency [4]
- Debride overlying ulcer and send bone specimen for histology and culture.
- No empiric antimicrobial therapy unless acutely ill.
- Antibiotic therapy should be based on culture results and treat for 6 weeks.
- Revascularize if possible.
Osteomyelitis, diabetic foot
- 1. Chronic Infection or Recent Antibiotic Use [5]
- Preferred regimen (1): Levofloxacin 750 mg IV/PO q24h
- Preferred regimen (2): Cefoxitin 1 g IV q4h (or 2 g IV q6–8h)
- Preferred regimen (3): Ceftriaxone 1–2 g/day IV/IM q12–24h
- Preferred regimen (4): Ampicillin-Sulbactam 1.5–3 g IV/IM q6h
- Preferred regimen (5): Moxifloxacin 400 mg IV/PO q24h
- Preferred regimen (6): Ertapenem 1 g IV/IM q24h
- Preferred regimen (7): Tigecycline 100 mg IV THEN 50 mg IV q12h (active against MRSA)
- Preferred regimen (8): Imipenem-Cilastatin 0.5–1 g IV q6–8h (Not active against MRSA; consider when ESBL-producing pathogens suspected)
- Alternative regimen (1): Levofloxacin 750 mg IV/PO q24h AND Clindamycin 150–300 mg PO qid
- Alternative regimen (2): Ciprofloxacin 600–1200 mg/day IV q6–12h AND Clindamycin 150–300 mg PO qid
- Alternative regimen (3): Ciprofloxacin 1200–2700 mg IV q6–12h (for more severe cases) AND Clindamycin 150–300 mg PO qid
- 2. High Risk for MRSA
- Preferred regimen (1): Linezolid 600 mg IV/PO q12h
- Preferred regimen (2): Daptomycin 4 mg/kg IV q24h
- Preferred regimen (3): Vancomycin 15–20 mg/kg IV q8–12h (trough: 10–20 mg/L)
- 3. High Risk for Pseudomonas aeruginosa
- Preferred regimen: Piperacillin–Tazobactam 3.375 g IV q6–8h
- 4. Polymicrobial Infection
- Preferred regimen: (Vancomycin 15–20 mg/kg IV q8–12h (trough: 10–20 mg/L) 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 q8h)
- Alternative regimen: (Vancomycin 15–20 mg/kg IV q8–12h (trough: 10–20 mg/L) OR Linezolid 600 mg IV/PO q12h OR Daptomycin 4 mg/kg IV q24h) AND (Ceftazidime 2 g IV q8h OR Cefepime 2 g IV q8h OR Aztreonam 2 g IV q6–8h) AND Metronidazole 15 mg/kg IV, then 7.5 mg/kg IV q6h
Osteomyelitis, foot bone
- Foot bone osteomyelitis due to nail through tennis shoe [6]
- Preferred regimen (1): Ciprofloxacin 750 mg PO bid
- Preferred regimen (2): Levofloxacin 750 mg PO q24h
- Alternative regimen (1): Ceftazidime 2 g IV q8h
- Alternative regimen (2): Cefepime 2 g IV q12h
Osteomyelitis, foot puncture wound
- Long bone, post-internal fixation of fracture [7]
- 1. S. aureus or P. aeruginosa
- Preferred regimen: Vancomycin 1 g IV q12h AND (Ceftazidime OR Cefepime)
- Alternative regimen (1): Linezolid 600 mg IV/PO bidNAI AND Ceftazidime
- Alternative regimen (2): Linezolid 600 mg IV/PO bidNAI AND Cefepime
- 2. Gm-neg. bacilli
- Preferred regimen (1): Ciprofloxacin 750 mg po bid
- Preferred regimen (2): Levofloxacin 750 mg po qd
Osteomyelitis, hematogenous
- 1. Empiric therapy [8]
- 1.1 Adult (>21 yrs)
- 1.1.1 MRSA possible
- Preferred regimen: Vancomycin 1 g IV q12h (if over 100 kg, 1.5 g IV q12h)
- 1.1.2 MRSA unlikely
- 1.2 Children (>4 mos.)-Adult
- 1.2.1 MRSA possible
- Preferred regimen: Vancomycin 40 div q6–8h
- 1.2.2 MRSA unlikely
- Note: Add Ceftazidime 50 q8h or Cefepime 150 div q8h if Gm-neg. bacilli on Gram stain
- 1.3 Newborn (<4 mos.)
- 1.3.1 MRSA possible
- Preferred regimen: Vancomycin AND (Ceftazidime 2 g IV q8h or Cefepime 2 g IV q12h)
- 1.3.2 MRSA unlikely
- Preferred regimen: (Nafcillin OR Oxacillin) AND (Ceftazidime OR Cefepime)
- 2. Specific therapy
- 2.1 MSSA
- Preferred regimen: Nafcillin OR Oxacillin 2 g IV q4h OR Cefazolin 2 g IV q8h
- Alternative regimen: Vancomycin 1 g IV q12h (if over 100 kg, 1.5 g IV q12h)
- 2.2 MRSA
- Preferred regimen: Vancomycin 1 g IV q12h
- Alternative regimen: Linezolid 600 mg q12h IV/po ± Rifampin 300 mg po/IV bid
Osteomyelitis, hemoglobinopathy
- Osteomyelitis, hemoglobinopathy [9]
- Preferred regimen: Ciprofloxacin 400 mg IV q12h
- Alternative regimen: Levofloxacin 750 mg IV q24h
Osteomyelitis, spinal implant
- Culture, treat & then suppress until fusion occurs
- Main parenteral antimicrobial therapy
- Preferred regimen: Beta-lactam antibiotic OR Vancomycin
- Suppressive antimicrobial therapy strategy
- Preferred regimen: Beta-lactam antibiotic OR Minocycline
- 2. Onset after 30 days
- Remove implant, culture & treat
- Main parenteral antimicrobial therapy
- Preferred regimen: Beta-lactam antibiotic OR Vancomycin OR Combination therapy
- Suppressive antimicrobial therapy strategy
- Preferred regimen: Combination therapy OR Minocycline
Osteomyelitis, vertebral
- 1. OSSA or coagulase-negative staphylococci
- Preferred regimen (1): Oxacillin 2 g IV q6h
- Preferred regimen (2): Cefazolin 1–2 g IV q8h
- Alternative regimen: Levofloxacin 750 mg PO qd AND Rifampin 300 mg PO bid
- 2. ORSA
- Preferred regimen: Vancomycin 1 g IV q12h
- Alternative regimen (1): Daptomycin 6 mg/kg IV q24h
- Alternative regimen (2): Levofloxacin 500–750 mg/day PO/IV AND Rifampin 600–900 mg PO qd
- 3. Streptococcus
- Preferred regimen: Penicillin G 5 MU IV q6h
- Alternative regimen: Ceftriaxone 2 g IV q24h
- 4. Enterobacteriaceae, quinolone-susceptible
- Preferred regimen: Ciprofloxacin 750 mg PO q12h
- Alternative regimen: Ceftriaxone 2 g IV q24h
- 5. Enterobacteriaceae, quinolone-resistant
- Preferred regimen: Imipenem 500 mg IV q6h
- 6. Pseudomonas aeruginosa
- Preferred regimen: (Cefepime 2 g IV q8h OR Ceftazidime 2 g IV q8h for 2–4 weeks), followed by Ciprofloxacin 750 mg PO bid
- Alternative regimen: Piperacillin–Tazobactam 750 mg PO q12h for 2–4 weeks, followed by Ciprofloxacin 750 mg PO bid
- 7. Anaerobes
- Preferred regimen: Piperacillin–Tazobactam 750 mg PO q12h for 2–4 weeks, followed by Ciprofloxacin 750 mg PO bid
- Alternative regimen (1): Penicillin G 5 MU IV q6h
- Alternative regimen (2): Ceftriaxone 2 g IV q24h (against gram-positive anaerobes)
- Alternative regimen (3): Metronidazole 500 mg PO tid (against gram-negative anaerobes)
Osteomyelitis, sternal
- Osteomyelitis, sternal [14]
- Preferred regimen: Vancomycin 1 g IV q12h (If over 100kg, 1.5 g IV q12h)
- Alternative regimen: Linezolid 600 mg po/IVNAI bid
Osteonecrosis of the jaw
- 1. Bacterial Infection [15]
- Preferred regimen (1): Penicillin VK 500 mg PO q6–8h for 7–10 days (maintenance: 500 mg PO bid)
- Preferred regimen (2): Amoxicillin 500 mg PO q8h for 7–10 days (maintenance: 500 mg PO bid)
- Alternative regimen (1): Clindamycin 150–300 mg PO qid
- Alternative regimen (2): Doxycycline 100 mg PO qd
- Alternative regimen (3): Erythromycin 400 mg PO tid
- Alternative regimen (4): Azithromycin 500 mg PO single dose THEN 250 mg PO qd for 4 days
- Alternative regimen (5): Levofloxacin 500 mg PO qd
- Alternative regimen (6): Moxifloxacin 400 mg PO qd
- 2. Fungal Infection
- Preferred regimen (1): Nystatin oral suspension 5–15 mL swish qid
- Preferred regimen (2): Fluconazole 200 mg PO qd THEN 100 mg q24h
- Preferred regimen (3): Clotrimazole 10 mg PO tid for 7–10 days
- 3. Viral Infection
- Preferred regimen (1): Acyclovir 400 mg PO bid
- Preferred regimen (2): Valacyclovir 0.5–2.0 g PO bid
Reactive arthritis, post-streptococcal arthritis
- Reactive arthritis, post-streptococcal arthritis [16]
- Treat strep pharyngitis and then NSAIDs (Prednisone needed in some patients)
Reactive arthritis, Reiter's syndrome
- Reactive arthritis, Reiter's syndrome [17]
- Only treatment is non-steroidal anti-inflammatory drugs
Septic arthritis, Brucella melitensis
- Septic arthritis, Brucella melitensis [18]
- Preferred Regimen: Doxycycline 100 mg PO bid for ≥ 6 weeks AND Streptomycin 15 mg/kg IM qd for 2–3 weeks OR Rifampin 600–900 mg qd for ≥ 6 weeks
- Alternative Regimen: Doxycycline 100 mg PO bid for ≥ 6 weeks AND Gentamicin 5 mg/kg IV qd for 7 days
Septic arthritis, candidal
- Septic arthritis, candidal [2]
- Preferred regimen (1): Fluconazole 400 mg/day (6 mg/kg/day) for at least 6 weeks
- Preferred regimen (2): Amphotericin B 3–5 mg/kg/day for several weeks THEN Fluconazole to completion
- Alternative regimen (1): Anidulafungin 200-mg loading dose THEN 100 mg/day
- Alternative regimen (2): Caspofungin 70-mg loading dose THEN 50 mg/day
- Alternative regimen (3): Micafungin 100 mg/day
- Alternative regimen (4): Amphotericin B deoxycholate 0.5–1 mg/kg/day for several weeks THEN Fluconazole to completion
- Note: Duration of therapy usually is for at least 6 weeks, but few data are available; Surgical debridement is recommended for all cases; For infected prosthetic joints, removal is recommended for most cases.
Septic arthritis, gonococcal
- Septic arthritis, gonococcal [19]
- Preferred regimen: Ceftriaxone 1 g intramuscularly IM/IV q24h
- Alternative regimen (1): Cefotaxime 1 g IV q8h
- Alternative regimen (2): Ceftizoxime 1 g IV q8h
- Alternative regimen (3): Spectinomycin 2 g IV q12h (Penicillin allergies)
- Alternative regimen (4): Ciprofloxacin 500 mg IV q12h OR Ofloxacin 400 mg IV q12h (β-lactam-allergic patient)
- Note: The tetracyclines (except in pregnant women) or penicillins may be used if the infecting organism is proven to be susceptible
- Pediatric regimen:
- >45 kg
- Preferred regimen: Ceftriaxone 50 mg/kg (Maximum, 2 g/dose) IM/IV single dose for 10 to 14 days
- <45 kg
- Preferred regimen: Ceftriaxone 50 mg/kg (Maximum, 1 g/dose) IM/IV single dose for 7 days
Septic arthritis, Gram-negative bacilli
- Septic arthritis, Gram-negative bacilli [20]
- Preferred regimen (1): Ceftazidime 2 g IV q8h
- Preferred regimen (2): Cefepime 2 g IV q8–12h
- Preferred regimen (3): Piperacillin-Tazobactam 4.5 g IV q6h
- Alternative regimen (1): Aztreonam 2 g IV q8h
- Alternative regimen (2): Imipenem 500 mg IV q6h
- Alternative regimen (3): Meropenem 1 g IV q8h
- Alternative regimen (4): Doripenem 500 mg IV q8h
- Alternative regimen (5): Carbapenems
Septic arthritis, Histoplasmosis
- Septic arthritis, histoplasmosis[21]
- 1. Mild disease
- Preferred regimen: Nonsteroidal anti-inflammatory drug
- 2. Severe disease
- Preferred regimen: Prednisone 0.5–1.0 mg/kg/day (Maximum, 80 mg/day) in tapering doses over 1–2 weeks AND Itraconazole 200 mg tid for 3 days, followed by qd or bid for 6–12 weeks
Septic arthritis, Lyme disease
- Septic arthritis, Lyme disease [22]
- 1. Patients without clinical evidence of neurologic disease
- Preferred regimen (1): Doxycycline 100 mg bid for 28 days
- Preferred regimen (2): Amoxicillin 500 mg tid for 28 days
- Preferred regimen (3): Cefuroxime axetil 500 mg bid for 28 days
- Pediatric regimen (1): Amoxicillin 50 mg/kg/day tid (Maximum, 500 mg/dose)
- Pediatric regimen (2): Cefuroxime axetil 30 mg/kg/day bid (Maximum, 500 mg/dose)
- Pediatric regimen (3): (if the patient is ≥8 years of age) Doxycycline 4 mg/kg/day bid (Maximum, 100 mg/dose)
- 2. Patients with arthritis and objective evidence of neurologic disease
- Preferred regimen: Ceftriaxone administered parenterally for 2–4 weeks
- Alternative regimen: Cefotaxime OR Penicillin G administered parenterally
- Pediatric regimen: Ceftriaxone OR Cefotaxime OR Penicillin G administered intravenously
- Note (1): For patients who have persistent or recurrent joint swelling after a recommended course of oral antibiotic therapy, we recommend re-treatment with another 4-week course of oral antibiotics or with a 2–4-week course of Ceftriaxone IV
- Note (2): If patients have no resolution of arthritis despite intravenous therapy and if PCR results for a sample of synovial fluid (and synovial tissue if available) are negative, symptomatic treatment is recommended, which consist of nonsteroidal anti-inflammatory agents, intra-articular injections of corticosteroids, or disease-modifying antirheumatic drugs (DMARDs), such as Hydroxychloroquine.
Septic arthritis, Mycobacterium tuberculosis
- Septic arthritis, Mycobacterium tuberculosis[23]
- 1. Septic arthritis caused by susceptible Mycobacterium tuberculosis
- 1.1 Adults
- 1.1.1 Intensive phase
- Preferred regimen: Isoniazid 5 mg/kg (max, 300 mg) for 2 months AND Rifampin 10 mg/kg (max: 600 mg) for 2 months AND Pyrazinamide 15–30 mg/kg (max: 2 g) for 2 months AND Ethambutol 15–20 mg/kg (max: 1 g) for 2 months
- 1.1.2 Continuation phase
- 1.2 Pediatric
- 1.2.1 Intensive phase
- Preferred regimen: Isoniazid 10–15 mg/kg (max: 300 mg) for 2 months AND Rifampin 10–20 mg/kg (max: 600 mg) for 2 months AND Pyrazinamide 15–30 mg/kg (max: 2 g) for 2 months AND Ethambutol 15–20 mg/kg (max: 1 g) for 2 months
- 1.2.2 Continuation phase
- 2. Specific considerations
- 2.1 Pregnancy and breastfeeding
- With the exception of streptomycin, the first line anti-TB drugs are safe for use in pregnancy: Streptomycin is ototoxic to the fetus and should not be used during pregnancy.
- After active TB in the baby is ruled out, the baby should be given 6 months of isoniazid preventive therapy, followed by BCG vaccination.
- Pyridoxine supplementation is recommended for all pregnant or breastfeeding women taking isoniazid.
- 2.2 Liver disorders
- Two hepatotoxic drugs (rather than the three in the standard regimen):
- 9 months of Isoniazid AND Rifampicin AND Ethambutol (until or unless Isoniazid susceptibility is documented).
- 2 months of Isoniazid AND Rifampicin AND Streptomycin AND Ethambutol, followed by 6 months of Isoniazid AND Rifampicin.
- 6–9 months of Rifampicin AND Pyrazinamide AND Ethambutol
- One hepatotoxic drug:
- 2 months of Isoniazid AND Ethambutol AND Streptomycin, followed by 10 months of Isoniazid AND Ethambutol
- No hepatotoxic drugs:
- 18–24 months of Streptomycin AND Ethambutol AND a Fluoroquinolone
- 2.3 Renal failure and severe renal insufficiency
- The recommended initial TB treatment regimen for patients with renal failure or severe renal insufficiency is 2 months of isoniazid, rifampicin, pyrazinamide and ethambutol, followed by 4 months of isoniazid and rifampicin.
- There is significant renal excretion of ethambutol and metabolites of pyrazinamide, and doses should therefore be adjusted.
- Three times per week administration of these two drugs at the following doses is recommended: pyrazinamide (25 mg/kg), and ethambutol (15 mg/kg)
- While receiving isoniazid, patients with severe renal insufficiency or failure should also be given pyridoxine in order to prevent peripheral neuropathy.
- Because of an increased risk of nephrotoxicity and ototoxicity, Streptomycin should be avoided in patients with renal failure. If Streptomycin must be used, the dosage is 15 mg/kg, two or three times per week, to a maximum of 1 gram per dose, and serum levels of the drug should be monitored.
- 2.4 Previously treated patients in settings with rapid DST
- TB patients whose treatment has failed or other patient groups with high likelihood of multidrug-resistant TB (MDR) should be started on an empirical MDR regimen.
- TB patients returning after defaulting or relapsing from their first treatment course may receive the retreatment regimen containing first-line drugs 2HRZES/1HRZE/5HRE if country-specific data show low or medium levels of MDR in these patients or if such data are not available.
- 2.5 TB treatment in people living with HIV
- TB patients with known positive HIV status and all TB patients living in HIV prevalent settings should receive daily TB treatment at least during the intensive phase.
- For the continuation phase, the optimal dosing frequency is also daily for these patients.
- If a daily continuation phase is not possible for these patients, three times weekly dosing during the continuation phase is an acceptable alternative.
- It is recommended that TB patients who are living with HIV should receive at least the same duration of TB treatment as HIV-negative TB patients.
Septic arthritis, pneumococcal
Septic arthritis, post-intraarticular injection
- Septic arthritis, post-intraarticular injection [24]
- NO empiric therapy.
Septic arthritis, prosthetic joint infection
- Septic arthritis, prosthetic joint infection (device-related osteoarticular infections) [25]
- 1. Empiric antimicrobial therapy
- It is preferable to delay antibiotic therapy until specimens for culture are obtained by joint aspiration, joint debridement, and/or prosthesis removal.
- 2. Pathogen-directed antimicrobial therapy
- 2.1 Staphylococcus aureus, methicillin-susceptible (MSSA)
- Preferred regimen (1): Nafcillin 2 g IV q4–6h
- Alternative regimen (2): Ceftriaxone 2 g IV q24h
- Alternative regimen (3): (if allergic to penicillins) Clindamycin 900 mg IV q8h
- Alternative regimen (4): (if allergic to penicillins) Vancomycin 15–20 mg/kg IV q8–12h (Maximum, 2 g/dose)
- 2.2 Staphylococcus, methicillin-resistant (MRSA)
- 2.2.1 Early-onset or acute hematogenous prosthetic joint infections involving a stable implant with short duration (< 3 weeks) of symptoms and debridement (but device retention)
- Preferred regimen: Vancomycin AND Rifampin 600 mg PO qd or 300–450 mg PO bid for 2 weeks
- Alternative regimen: (Daptomycin 6 mg/kg IV q24h OR Linezolid 600 IV q8h) AND Rifampin 600 mg PO qd or 300–450 mg PO bid for 2 weeks
- Note: The above regimen should be followed by Rifampin plus a fluoroquinolone, TMP/SMX, a tetracycline or Clindamycin for 3 or 6 months for hips and knees, respectively.
- 2.2.2 Early-onset spinal implant infections or implants in an actively infected site
- 2.3 Streptococci, beta-hemolytic
- Preferred regimen (1): Penicillin 12–18 MU/day IV q6h
- Preferred regimen (2): Ampicillin 2 g IV q6h
- Preferred regimen (3): Ceftriaxone 1–2 g IV q24h
- Alternative regimen (1): (if allergic to penicillins) Clindamycin 900 mg IV q8h
- Alternative regimen (2): (if allergic to penicillins) Vancomycin 15–20 mg/kg IV q8–12h (Maximum, 2 g/dose)
- 2.4 Enterococci
- 2.4.1 Monotherapy
- Preferred regimen (1): Ampicillin 6-12 g/day q4-6h
- Preferred regimen (2): Penicillin G 18-30 MU/day continuously or q4h
- Preferred regimen (3): Vancomycin 15-20 mg/kg/dose q8-12h (Maximum, 2 g/dose)
- 2.4.2 Combination therapy (one of the monotherapy agents, and one of the following agents)
- Preferred regimen (1): Gentamicin 1 mg/kg IV q8h
- Preferred regimen (2): Streptomycin 7.5 mg/kg IV q12h
- Preferred regimen (3): Ampicillin 2 g/day IV q6h AND Ceftriaxone 2 g IV q12h
- 2.5 Gram-negative bacilli
- Patients susceptible to fluoroquinolones
- Preferred regimen: Ciprofloxacin 500-750 mg bid
- 2.5.1 P. aeruginosa
- Preferred regimen (1): Cefepime 2 g IV q12h
- Preferred regimen (2): Meropenem 1 g IV q8h
- Alternative regimen (1): Ciprofloxacin 750 mg PO bid
- Alternative regimen (2): Ceftazidime 2 g IV q8h
- 2.6 Anaerobes
- 2.6.1Propionibacterium acnes
- Preferred regimen (1): Penicillin 24 MU/day IV q4h or continuously
- Preferred regimen (2): Ceftriaxone 1-2 g/day IV
- Alternative regimen: Vancomycin OR Clindamycin
- 2.6.2 Not Propionibacterium acnes
- Preferred regimen: Metronidazole 500 mg PO tid
- 2.7 Mycobacterium tuberculosis
- Preferred regimen: see (Septic arthritis, Mycobacterium tuberculosis)
- 2.8 Fungi
- Preferred regimen: see (Septic arthritis, candidal)
- 2.9 Culture negative
- Preferred regimen: Vancomycin AND Ciprofloxacin OR Cefazolin AND Ciprofloxacin
Septic arthritis, staphylococcal
- Preferred regime: Vancomycin 15–20 mg/kg IV q8–12h
- Alternative regimen (1): Daptomycin 6 mg/kg IV q24h
- Alternative regimen (2): Linezolid 600 mg PO/IV q12h
- Alternative regimen (3): Clindamycin 600 mg PO/IV q8h
- Alternative regimen (4): TMP-SMX 3.5–4.0 mg/kg PO/IV q8–12h
- Pediatric regimen(1): Vancomycin 15 mg/kg IV q6h
- Pediatric regimen(1): Daptomycin 6–10 mg/kg IV q24h
- Pediatric regimen(1): Linezolid 10 mg/kg PO/IV q8h
- Pediatric regimen(1): Clindamycin 10–13 mg/kg/dose PO/IV q6–8h
2. Staphylococcus aureus (methicillin-susceptible)
- Preferred regimen (1): Nafcillin 2 g IV q6h
- Preferred regimen (2): Clindamycin 900 mg IV q8h
- Alternative regimen (1): Cefazolin 0.25–1 g IV/IM q6–8h
- Alternative regimen (2): Vancomycin 500 mg IV q6h or 1 g IV q12h
3. Staphylococcus epidermidis (methicillin-resistant)
- Preferred regimen (1): Vancomycin 500 mg IV q6h or 1 g IV q12h
- Preferred regimen (2): Linezolid 600 mg IV q12h
- Alternative regimen: (TMP-SMX 3.5–4.0 mg/kg PO/IV q8–12h (TMP component) OR Minocycline 200 mg PO single dose THEN 100 mg PO q12h) AND Rifampin 300–600 mg PO/IV q12h
4. Staphylococcus epidermidis (methicillin-susceptible)
- Preferred regimen (1): Nafcillin 2 g IV q6h
- Preferred regimen (2): Clindamycin 900 mg IV q8h
- Alternative regimen (1): Cefazolin 0.25–1 g IV/IM q6–8h
- Alternative regimen (2): Vancomycin 500 mg IV q6h or 1 g IV q12h
Septic arthritis, streptococcal
1. Streptococcus agalactiae [28]
- Preferred regimen (1): Penicillin G 2 MU IV/IM q4h
- Preferred regimen (2): Ampicillin 2 g IV q6h
- Alternative regimen (1): Clindamycin 600–1200 mg/day IV/IM q6–12h
- Alternative regimen (2): Cefazolin 0.25–1 g IV/IM q6–8h
2. Streptococcus pyogenes
- Preferred regimen (1): Penicillin G 2 MU IV/IM q4h
- Preferred regimen (2): Ampicillin 2 g IV q6h
- Alternative regimen (1): Clindamycin 600–1200 mg/day IV/IM q6–12h
- Alternative regimen (2): Cefazolin 0.25–1 g IV/IM q6–8h
References
- ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
- ↑ 2.0 2.1 Pappas PG, Kauffman CA, Andes D, Benjamin DK, Calandra TF, Edwards JE; et al. (2009). "Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America". Clin Infect Dis. 48 (5): 503–35. doi:10.1086/596757. PMID 19191635.
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- ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
- ↑ Lipsky BA, Berendt AR, Cornia PB, Pile JC, Peters EJ, Armstrong DG; et al. (2013). "2012 infectious diseases society of america clinical practice guideline for the diagnosis and treatment of diabetic foot infections". J Am Podiatr Med Assoc. 103 (1): 2–7. PMID 23328846.
- ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
- ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
- ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
- ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
- ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
- ↑ Kowalski TJ, Berbari EF, Huddleston PM, Steckelberg JM, Mandrekar JN, Osmon DR (2007). "The management and outcome of spinal implant infections: contemporary retrospective cohort study". Clin Infect Dis. 44 (7): 913–20. doi:10.1086/512194. PMID 17342641.
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- ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
- ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
- ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
- ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
- ↑ Corbel, Michael (2006). Brucellosis in humans and animals. Geneva: World Health Organization. ISBN 9241547138.
- ↑ Shirtliff ME, Mader JT (2002). "Acute septic arthritis". Clin Microbiol Rev. 15 (4): 527–44. PMC 126863. PMID 12364368.
- ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
- ↑ Wheat LJ, Freifeld AG, Kleiman MB, Baddley JW, McKinsey DS, Loyd JE; et al. (2007). "Clinical practice guidelines for the management of patients with histoplasmosis: 2007 update by the Infectious Diseases Society of America". Clin Infect Dis. 45 (7): 807–25. doi:10.1086/521259. PMID 17806045.
- ↑ Wormser GP, Dattwyler RJ, Shapiro ED, Halperin JJ, Steere AC, Klempner MS; et al. (2006). "The clinical assessment, treatment, and prevention of lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America". Clin Infect Dis. 43 (9): 1089–134. doi:10.1086/508667. PMID 17029130.
- ↑ Treatment of Tuberculosis: Guidelines. WHO Guidelines Approved by the Guidelines Review Committee (4th ed.). Geneva: World Health Organization. 2010. ISBN 9789241547833. PMID 23741786. Retrieved 2015-06-08.
- ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
- ↑ Osmon DR, Berbari EF, Berendt AR, Lew D, Zimmerli W, Steckelberg JM; et al. (2013). "Executive summary: diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America". Clin Infect Dis. 56 (1): 1–10. doi:10.1093/cid/cis966. PMID 23230301.
- ↑ Liu C, Bayer A, Cosgrove SE, Daum RS, Fridkin SK, Gorwitz RJ; et al. (2011). "Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children". Clin Infect Dis. 52 (3): e18–55. doi:10.1093/cid/ciq146. PMID 21208910.
- ↑ 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.
- ↑ "Clinical Management of Septic Arthritis" (PDF).