Sandbox ID Musculoskeletal: Difference between revisions

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===Bursitis===
===Bursitis===


* Olecranon bursitis or prepatellar 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>
:* Staphylococcus aureus, methicillin-susceptible (MSSA)
:*1. '''Staphylococcus aureus, methicillin-susceptible (MSSA)'''
::* Preferred regimen: [[Nafcillin]] 2 g IV q4h {{or}} [[Oxacillin]] 2 g IV q4h {{or}} [[Dicloxacillin]] 500 mg PO qid
::* Preferred regimen (1): [[Nafcillin]] 2 g IV q4h
:* Staphylococcus aureus, methicillin-resistant (MRSA)
 
::* Preferred regimen: [[Vancomycin]] 1 g IV q12h {{or}} [[Linezolid]] 600 mg PO qd
::* Preferred regimen (2): [[Oxacillin]] 2 g IV q4h
::: Note: Initially aspirate q24h and treat for a minimum of 2–3 weeks.
 
::* 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>
* 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: Fluconazole 400 mg (6 mg/kg) daily for 6–12 months {{or}} lipid formulation of amphotericin B 3–5 mg/kg daily for several weeks, then fluconazole for 6–12 months
:* 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 (1): (Anidulafungin 200-mg loading dose, then 100 mg/day {{or}} Caspofungin, 70-mg loading dose, then 50 mg/day {{or}} Micafungin 100 mg/day), then fluconazole for 6–12 months
:* Alternative regimen (3): [[Micafungin]] 100 mg/day PO
:* Alternative regimen (2): Amphotericin B deoxycholate 0.5–1 mg/kg daily for several weeks, then Fluconazole for 6–12 months
:* 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
:* 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


:*OSSA
::* 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
::* Preferred regimen: Oxacillin 1.5–2 g IV q4h for 4–6 wk {{or}} Cefazolin 1–2 g IV q8h for 4–6 wk
::* 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


::* Alternative regimen (1): Vancomycin 15 mg/kg IV q12h for 4–6 wk
::* Preferred regimen (2): [[Ertapenem]] 1 g IV q24h
::* Alternative regimen (2): Oxacillin 1.5–2 g IV q4h for 4–6 wk {{and}} Rifampin 600 mg PO qd
::* Alternative regimen (1): [[Levofloxacin]] 500–750 mg PO qd


:*ORSA
::* Alternative regimen (2): [[Ciprofloxacin]] 500–750 mg PO bid for 4–6 weeks
::* Preferred regimen: Vancomycin 15 mg/kg IV q12h for 4–6 wk {{or}} Daptomycin 6 mg/kg IV q24h
:*1.6 '''Pseudomonas aeruginosa'''
::* Alternative regimen (1): Linezolid 600 mg PO/IV q12h for 6 wk {{withorwithout}} Rifampin 600–900 mg PO qd
::* Preferred regimen (1): [[Cefepime]] 2 g IV q12h
::* Alternative regimen (2): Levofloxacin 500–750 mg PO/IV daily {{withorwithout}} Rifampin 600–900 mg PO qd
:*Penicillin-sensitive Streptococcus
::* Preferred regimen: Penicillin G 20 MU/day IV continuously or q4h for 4–6 wk {{or}} Ceftriaxone 1–2 g IV/IM q24h for 4–6 wk {{or}} Cefazolin 1–2 g IV q8h for 4–6 wk
::* Alternative regimen: Vancomycin 15 mg/kg IV q12h for 4–6 wk


:*Enterococcus or Streptococcus (MIC≥0.5 μg/mL) or Abiotrophia or Granulicatella
::* Preferred regimen (2): [[Meropenem]] 1 g IV q8h
::* Preferred regimen: Penicillin G 20 MU/day IV continuously or q4h for 4–6 wk {{withorwithout}} Gentamicin 1 mg/kg IV or IM q8h for 1–2 wk {{or}} Ampicillin 12 g/day IV continuously or q4h for 4–6 wk {{withorwithout}} Gentamicin 1 mg/kg IV or IM q8h for 1–2 wk


::* Alternative regimen: Vancomycin 15 mg/kg IV q12h for 4–6 wk {{withorwithout}} Gentamicin 1 mg/kg IV or IM q8h for 1–2 wk
::* Preferred regimen (3): [[Imipenem]] 500 mg IV q6h for 4–6 weeks
:*Enterobacteriaceae
::* Alternative regimen (1): [[Ciprofloxacin]] 750 mg PO q12h
::* Preferred regimen: Ceftriaxone 1–2 g IV/IM q24h for 4–6 wk {{or}} Ertapenem 1 g IV q24h
::* Alternative regimen: Levofloxacin 500–750 mg PO q24h {{or}} Ciprofloxacin 500–750 mg PO q12h for 4–6 wk
:*Pseudomonas aeruginosa
::* Preferred regimen: Cefepime 2 g IV q12h {{or}} Meropenem 1 g IV q8h {{or}} Imipenem 500 mg IV q6h for 4–6 wk
::* Alternative regimen: Ciprofloxacin 750 mg PO q12h {{or}} Ceftazidime 2 g IV q8h for 4–6 wk


* Chronic Osteomyelitis in Children – Pathogen-Based Therapy
::* Alternative regimen (2): [[Ceftazidime]] 2 g IV q8h for 4–6 weeks
:* ''Group A beta-hemolytic Streptococcus, Haemophilus influenzae type b, andStreptococcus pneumoniae''
::* Preferred regimen: Ampicillin 150–200 mg/kg/day administered in 4 equal doses {{or}} Amoxicillin 150–200 mg/kg/day administered in 4 equal doses


::* Alternative regimen: Chloramphenicol 75 mg/kg/day administered in 3 equal doses
*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===


* 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.  
:* Debride overlying ulcer and send bone specimen for histology and culture.  
:* No empiric antimicrobial therapy unless acutely ill.
:* No empiric antimicrobial therapy unless acutely ill.
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===Osteomyelitis, diabetic foot===
===Osteomyelitis, diabetic foot===
* Chronic Infection or Recent Antibiotic Use
*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: 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 (active against MRSA) {{or}} Imipenem–Cilastatin 0.5–1 g IV q6–8h (Not active against MRSA; consider when ESBL-producing pathogens suspected)
:* Preferred regimen (1): [[Levofloxacin]] 750 mg IV/PO q24h  


:* Alternative regimen (1): Levofloxacin 750 mg IV/PO q24h {{and}} Clindamycin 150–300 mg PO qid
:* Preferred regimen (2): [[Cefoxitin]] 1 g IV q4h (or 2 g IV q6–8h)
:* 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
:* Preferred regimen (3): [[Ceftriaxone]] 1–2 g/day IV/IM q12–24h 


* High Risk for MRSA
:* Preferred regimen (4): [[Ampicillin-Sulbactam]] 1.5–3 g IV/IM q6h 
:* Preferred regimen: 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)


* High Risk for ''Pseudomonas aeruginosa''
:* Preferred regimen (5): [[Moxifloxacin]] 400 mg IV/PO q24h


:* Preferred regimen: Piperacillin–Tazobactam 3.375 g IV q6–8h
:* Preferred regimen (6): [[Ertapenem]] 1 g IV/IM q24h 


* Polymicrobial Infection
:* Preferred regimen (7): [[Tigecycline]] 100 mg IV {{then}} 50 mg IV q12h (active against MRSA)


:* 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)
:* Preferred regimen (8): [[Imipenem-Cilastatin]] 0.5–1 g IV q6–8h (Not active against MRSA; consider when ESBL-producing pathogens suspected)
:* 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
:* 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===
* Empiric therapy
*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>
:* Adult (>21 yrs)
:*1.1 '''Adult (>21 yrs)'''
::* MRSA possible
::*1.1.1 '''MRSA possible'''
:::* Preferred regimen: Vancomycin 1 gm IV q12h (if over 100 kg, 1.5 gm IV q12h)
:::* Preferred regimen: [[Vancomycin]] 1 g IV q12h (if over 100 kg, 1.5 g IV q12h)
::* MRSA unlikely  
::*1.1.2 '''MRSA unlikely'''
:::* Preferred regimen: Nafcillin {{or}} Oxacillin 2 gm IV q4h
:::* 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 <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 


:* Children (>4 mos.)-Adult
::* Preferred regimen (2): [[Cefazolin]] 1–2 g IV q8h
::* MRSA possible
::* Alternative regimen: [[Levofloxacin]] 750 mg PO qd {{and}} [[Rifampin]] 300 mg PO bid
:::* Preferred regimen: Vancomycin
:*2. '''ORSA'''
::* MRSA unlikely
::* Preferred regimen: [[Vancomycin]] 1 g IV q12h
:::* Preferred regimen: Nafcillin {{or}} Oxacillin
::* Alternative regimen (1): [[Daptomycin]] 6 mg/kg IV q24h
::* NOTE: Add Ceftazidime or Cefepime if Gm-neg. bacilli on Gram stain 
::* 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


:* Newborn (<4 mos.)
::* Alternative regimen (2): [[Ceftriaxone]] 2 g IV q24h (against gram-positive anaerobes)
::* MRSA possible
::* Alternative regimen (3): [[Metronidazole]] 500 mg PO tid (against gram-negative anaerobes)
:::* Preferred regimen: Vancomycin {{and}} (Ceftazidime 2 gm IV q8h or Cefepime 2 gm IV q12h)  
::* MRSA unlikely
:::* Preferred regimen: (Nafcillin {{or}} Oxacillin) {{and}} (Ceftazidime {{or}} Cefepime)  


* Specific therapy
===Osteomyelitis, sternal===
:* MSSA
* 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:
:* Preferred regimen: [[Vancomycin]] 1 g IV q12h (If over 100kg, 1.5 g IV q12h)
::* Alternative regimen:
:* Alternative regimen: [[Linezolid]] 600 mg po/IV<sup>NAI</sup> bid
:* MRSA
::* Preferred regimen:
::* Alternative regimen:


===Osteomyelitis, hemoglobinopathy===
===Osteonecrosis of the jaw===
:* Preferred regimen: Ciprofloxacin 400 mg IV q12h
*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)


:* Alternative regimen: Levofloxacin 750 mg IV q24h
:* 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 


===Osteomyelitis, prosthetic joint infection===
:* Alternative regimen (2): [[Doxycycline]] 100 mg PO qd  


===Osteomyelitis, spinal implant===
:* Alternative regimen (3): [[Erythromycin]] 400 mg PO tid 


===Osteomyelitis, vertebral===
:* Alternative regimen (4): [[Azithromycin]] 500 mg PO single dose {{then}} 250 mg PO qd for 4 days 


* Vertebral Osteomyelitis – Pathogen-Based Therapy
:* Alternative regimen (5): [[Levofloxacin]] 500 mg PO qd
:* OSSA or coagulase-negative staphylococci
::* Preferred regimen: Oxacillin 2 g IV q6h {{or}} Cefazolin 1–2 g IV q8h
::* Alternative regimen: Levofloxacin 750 mg PO qd {{and}} Rifampin 300 mg PO bid
:* ORSA
::* Preferred regimen: Vancomycin 1 g IV q12h
::* Alternative regimen (1): Daptomycin ≥ 6 mg/kg IV q24h
::* Alternative regimen (2): Levofloxacin 500–750 mg PO/IV daily {{and}} Rifampin 600–900 mg PO qd
:* Streptococcus
::* Preferred regimen: Penicillin G 5 MU IV q6h
::* Alternative regimen: Ceftriaxone 2 g IV q24h
:* Enterobacteriaceae, quinolone-susceptible
::* Preferred regimen: Ciprofloxacin 750 mg PO q12h
::* Alternative regimen: Ceftriaxone 2 g IV q24h


:* Enterobacteriaceae, quinolone-resistant
:* Alternative regimen (6): [[Moxifloxacin]] 400 mg PO qd
::* Preferred regimen: Imipenem 500 mg IV q6h
*2. '''Fungal Infection'''
:* Preferred regimen (1): Nystatin oral suspension 5–15 mL swish qid 


:* Pseudomonas aeruginosa
:* Preferred regimen (2): [[Fluconazole]] 200 mg PO qd {{then}} 100 mg q24h  
::* Preferred regimen: Cefepime 2 g IV q8h {{or}} Ceftazidime 2 g IV q8h x 2–4 wk, followed by Ciprofloxacin 750 mg PO bid
::* Alternative regimen: Piperacillin–Tazobactam 750 mg PO q12h x 2–4 wk, followed by Ciprofloxacin 750 mg PO bid
:* Anaerobes
::* Preferred regimen: Piperacillin–Tazobactam 750 mg PO q12h x 2–4 wk, followed by Ciprofloxacin 750 mg PO bid
::* Alternative regimen (1): Penicillin G 5 MU IV q6h OR Ceftriaxone 2 g IV q24h (against gram-positive anaerobes)


::* Alternative regimen (2): Metronidazole 500 mg PO tid (against gram-negative anaerobes)
:* Preferred regimen (3): [[Clotrimazole]] 10 mg PO tid for 7–10 days
*3. '''Viral Infection'''
:* Preferred regimen (1): [[Acyclovir]] 400 mg PO bid 


===Osteomyelitis, sternal===
:* Preferred regimen (2): [[Valacyclovir]] 0.5–2.0 g PO bid
:* Preferred regimen: Surgical debridement is necessary;


===Reactive arthritis, post-streptococcal  arthritis===
===Reactive arthritis, post-streptococcal  arthritis===
:* Preferred regimen: Treat strep pharyngitis and then NSAIDs ([[Prednisone]] needed in some patients)
* 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===
:* Preferred regimen: Only treatment is non-steroidal anti-inflammatory drugs
* 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 OR Rifampin 600–900 mg qd for ≥ 6 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 regime: Fluconazole 400 mg (6 mg/kg) daily for at least 6 weeks {{or}} lipid formulation of amphotericin B 3–5 mg/kg daily for several weeks, then Fluconazole to completion
* 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 regime: Anidulafungin 200-mg loading dose, then 100 mg/day {{or}} [[Caspofungin]] 70-mg loading dose, then 50 mg/day {{or}} Micafungin 100 mg/day {{or}} Amphotericin B deoxycholate 0.5–1 mg/kg daily for several weeks then Fluconazole to completion
:* Preferred regimen (1): [[Fluconazole]] 400 mg/day (6 mg/kg/day) for at least 6 weeks
:* 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.
 
:* 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===
:* Preferred regime<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>: Ceftriaxone 1 g intramuscularly IM/IV every 24 h
* 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 regime: Cefotaxime 1 g IV every 8 hours {{or}} Ceftizoxime 1 g IV every 8 hours
:* Preferred regimen: [[Ceftriaxone]] 1 g intramuscularly IM/IV q24h
:* NOTE: The tetracyclines (except in pregnant women) or penicillins may be used if the infecting organism is proven to be susceptible; Penicillin allergies should be given Spectinomycin (2 g IV every 12 h);Alternative antibiotics in the β-lactam-allergic patient may be Ciprofloxacin (500 mg IV every 12 h) or Ofloxacin (400 mg IV every 12 h)
:* Alternative regimen (1): [[Cefotaxime]] 1 g IV q8h 
:* Pediatric regime: (>45 kg) single daily dose of Ceftriaxone (50 mg/kg and a maximum dose of 2 g, IM or IV) for 10 to 14 days; (<45 kg) Ceftriaxone (50 mg/kg and a maximum dose of 1 g, IM or IV in a single daily dose for 7 days)
 
:* 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 regime: Ceftazidime 2 g IV q8h {{or}} Cefepime 2 g IV q8–12h {{or}} Piperacillin-Tazobactam 4.5 g IV q6h
* 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 regimen (2): [[Imipenem]] 500 mg IV q6h 
 
:* Alternative regimen (3): [[Meropenem]] 1 g IV q8h 
 
:* Alternative regimen (4): [[Doripenem]] 500 mg IV q8h 


:* Alternative regime: Aztreonam 2 g IV q8h {{or}} Imipenem 500 mg IV q6h {{or}} Meropenem 1 g IV q8h {or}} Doripenem 500 mg IV q8h {{or}} Carbapenems
:* 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 (maximum: 80 mg daily) 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===
* 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 regime: Doxycycline 100 mg twice per day {{or}} Amoxicillin 500 mg 3 times per day {{or}} Cefuroxime Axetil 500 mg twice per day for 28 days
::* Preferred regimen (1): [[Doxycycline]] 100 mg bid for 28 days
::* Pediatric regime: Amoxicillin 50 mg/kg per day in 3 divided doses maximum of 500 mg per dose {{or}} Cefuroxime Axetil 30 mg/kg per day in 2 divided doses maximum of 500 mg per dose {{or}} (if the patient is ≥8 years of age) Doxycycline 4 mg/ kg per day in 2 divided doses (maximum of 100 mg per dose)
:* Patients with arthritis and objective evidence of neurologic disease
::* Preferred regime: Ceftriaxone administered parenterally for 2–4 weeks
::* Alternative regime: Cefotaxime {{or}} Penicillin G administered parenterally
::* Pediatric regime: 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===
::* Preferred regimen (2): [[Amoxicillin]] 500 mg tid for 28 days


* 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 (3): [[Cefuroxime axetil]] 500 mg bid for 28 days
::* Pediatric regimen (1): [[Amoxicillin]] 50 mg/kg/day tid (Maximum, 500 mg/dose)


:* Septic arthritis caused by susceptible Mycobacterium tuberculosis
::* Pediatric regimen (2): [[Cefuroxime axetil]] 30 mg/kg/day bid (Maximum, 500 mg/dose)
::* '''Intensive phase (adult)'''
:::* 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


::* '''Continuation phase (adult)'''
::* Pediatric regimen (3): (if the patient is ≥8 years of age) [[Doxycycline]] 4 mg/kg/day bid (Maximum, 100 mg/dose)
:::* Preferred regimen: [[Isoniazid]] 5 mg/kg (max: 300 mg) for 7 months {{and}} [[Rifampin]] 10 mg/kg (max: 600 mg) for 7 months
:*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.


::* '''Intensive phase (pediatric)'''
===Septic arthritis, Mycobacterium  tuberculosis===
:::* 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


::* '''Continuation phase (pediatric)'''
* 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: streptomycin is ototoxic to the fetus and should not be used during 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 isoniazid and rifampicin, plus ethambutol (until or unless isoniazid susceptibility is documented).
::::* 9 months of [[Isoniazid]] {{and}} [[Rifampicin]] {{and}} [[Ethambutol]] (until or unless [[Isoniazid]] susceptibility is documented).
::::* 2 months of isoniazid, rifampicin, streptomycin and ethambutol, followed by 6 months of isoniazid and rifampicin.
::::* 2 months of [[Isoniazid]] {{and}} [[Rifampicin]] {{and}} [[Streptomycin]] {{and}} [[Ethambutol]], followed by 6 months of [[Isoniazid]] {{and}} [[Rifampicin]].
::::* 6–9 months of rifampicin, pyrazinamide and ethambutol.
::::* 6–9 months of [[Rifampicin]] {{and}} [[Pyrazinamide]] {{and}} [[Ethambutol]]
 
:::* One hepatotoxic drug:
:::* One hepatotoxic drug:
::::* 2 months of isoniazid, ethambutol and streptomycin, followed by 10 months of isoniazid and ethambutol.
::::* 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 streptomycin, ethambutol and a fluoroquinolone.
::::* 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, 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.
:::* 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 255: 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 


:* Pathogen-directed antimicrobial therapy
:::* Preferred regimen (2): [[Oxacillin]] 2 g IV q4–6h  
::* Staphylococcus aureus, methicillin-susceptible (MSSA)
:::* Alternative regimen (1): [[Cefazolin]] 1–2 g IV q8h
:::* Preferred regimen: [[Nafcillin]] 2 g IV q4–6h {{or}} [[Oxacillin]] 2 g IV q4–6h


:::* Alternative regimen: [[Cefazolin]] 1–2 g IV q8h {{or}} [[Ceftriaxone]] 2 g IV q24h
:::* Alternative regimen (2): [[Ceftriaxone]] 2 g IV q24h
:::* Alternative regimen (if allergic to penicillins): [[Clindamycin]] 900 mg IV q8h {{or}} [[Vancomycin]] 15–20 mg/kg IV q8–12 hours, not to exceed 2 g per dose
:::* 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 (&lt; 2 months after surgery) or acute hematogenous prosthetic joint infections involving a stable implant with short duration (< 3 weeks) of symptoms and debridement (but device retention)
::*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.
::::* 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 (&lt; 30 days after surgery), or implants in an actively infected site
::::* Initial parenteral therapy plus [[Rifampin]] followed by prolonged oral therapy is recommended.
::::* Initial parenteral therapy plus rifampin followed by prolonged oral therapy is recommended.
::::* 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 rifampin due to the potential emergence of fluoroquinolone resistance)
::*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 {{or}} [[Ampicillin]] 2 g IV q6h {{or}} [[Ceftriaxone]] 1–2 g IV q24h
:::* Alternative regimen (allergic to penicillin): [[Clindamycin]] 900 mg IV q8h {{or}} [[Vancomycin]] 15–20 mg/kg q8–12h, not to exceed 2 g per dose


::* Enterococci
:::* Preferred regimen (2): [[Ampicillin]] 2 g IV q6h 
:::* Monotherapy
::::* Preferred regimen (1): Ampicillin 6 to 12 g per 24 hours in four to six equally divided doses
::::* Preferred regimen (2): Penicillin G 18 to 30 million units per 24 hours either continuously or in six equally divided doses
::::* Preferred regimen (3): Vancomycin 15 to 20 mg/kg/dose every 8 to 12 hours, not to exceed 2 g per dose


:::* 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 to 750 mg bid
::::* Preferred regimen: [[Ciprofloxacin]] 500-750 mg bid
:::* ''P. aeruginosa''
:::*2.5.1 '''P. aeruginosa'''
::::* Preferred regimen: Cefepime 2 g intravenously every 12 hours {{or}} Meropenem 1 g intravenously every 8 hours
::::* Preferred regimen (1): [[Cefepime]] 2 g IV q12h 
::::* Alternative regimen (1): Ciprofloxacin 750 mg orally every 12 hours Ceftazidime 2 g intravenously every 8 hours (alternative)
::::* Alternative regimen (2): Ceftazidime 2 g intravenously every 8 hours


::* Anaerobes
::::* Preferred regimen (2): [[Meropenem]] 1 g IV q8h
::''Propionibacterium acnes''
::::* Alternative regimen (1): [[Ciprofloxacin]] 750 mg PO bid
:::* Preferred regimen: Penicillin 24 million units intravenously every 24 hours given in six equally divided doses or as continuous infusion {{or}} Ceftriaxone 1 to 2 g intravenously once daily
::::* Alternative regimen (2): [[Ceftazidime]] 2 g IV q8h
:::* Alternative regimen: Vancomycin {{or}} Clindamycin
::*2.6 '''Anaerobes'''
:: Not ''Propionibacterium acnes''
:::*2.6.1'''Propionibacterium acnes'''
:::* Preferred regimen: Metronidazole 500 mg orally three times a day.
::::* 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:  vancomycin {{and}} Ciprofloxacin {{or}} Cefazolin {{and}} Ciprofloxacin


===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 (1): Daptomycin 6 mg/kg IV q24h in adults
:* Alternative regimen (2): [[Linezolid]] 600 mg PO/IV q12h
:* 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  
:* Alternative regimen (3): Clindamycin 600 mg PO/IV q8h
:* Pediatric regimen（1): [[Vancomycin]] 15 mg/kg IV q6h
:* Alternative regimen (4): TMP-SMX 3.5–4.0 mg/kg PO/IV q8–12h  
:* 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 


:* Pediatric regime: Vancomycin 15 mg/kg IV q6h {{or}} Daptomycin 6–10 mg/kg IV q24h {{or}} Linezolid 10 mg/kg PO/IV q8h {{or}} Clindamycin 10–13 mg/kg/dose PO/IV q6–8h
:* Preferred regimen (2): [[Clindamycin]] 900 mg IV q8h
 
:* Alternative regimen (1): [[Cefazolin]] 0.25–1 g IV/IM q6–8h  
''Staphylococcus aureus (methicillin-susceptible)''
:* Alternative regimen (2): [[Vancomycin]] 500 mg IV q6h or 1 g IV q12h
:* Preferred regime: Nafcillin 2 g IV q6h OR Clindamycin 900 mg IV q8h
3. '''Staphylococcus epidermidis (methicillin-resistant)'''
:* Alternative regime: Cefazolin 0.25–1 g IV/IM q6–8h {{or}} Vancomycin 500 mg IV q6h or 1 g IV q12h
:* Preferred regimen (1): [[Vancomycin]] 500 mg IV q6h or 1 g IV q12h  
 
:* Preferred regimen (2): [[Linezolid]] 600 mg IV q12h
''Staphylococcus epidermidis (methicillin-resistant)''
:* 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
:* Preferred regime: Vancomycin 500 mg IV q6h or 1 g IV q12h {{or}} Linezolid 600 mg IV q12h
4. '''Staphylococcus epidermidis (methicillin-susceptible)'''
:* Alternative regime: TMP-SMX 3.5–4.0 mg/kg PO/IV q8–12h (TMP component) {{or}} Minocycline 200 mg PO x 1 dose, then 100 mg PO q12h {{and}} Rifampin 300–600 mg PO/IV q12h
:* Preferred regimen (1): [[Nafcillin]] 2 g IV q6h
 
:* Preferred regimen (2): [[Clindamycin]] 900 mg IV q8h
''Staphylococcus epidermidis (methicillin-susceptible)''
:* Alternative regimen (1): [[Cefazolin]] 0.25–1 g IV/IM q6–8h  
:* Preferred regime: Nafcillin 2 g IV q6h OR Clindamycin 900 mg IV q8h
:* Alternative regimen (2): [[Vancomycin]] 500 mg IV q6h or 1 g IV q12h
:* Alternative regime: Cefazolin 0.25–1 g IV/IM q6–8h {{or}} Vancomycin 500 mg IV q6h or 1 g IV q12h


===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 regime: Penicillin G 2 MU IV/IM q4h {{or}} Ampicillin 2 g IV q6h
:* Preferred regimen (1): [[Penicillin G]] 2 MU IV/IM q4h
 
:* Preferred regimen (2): [[Ampicillin]] 2 g IV q6h
:* Alternative regime: Clindamycin 600–1200 mg/day IV/IM q6–12h {{or}} Cefazolin 0.25–1 g IV/IM q6–8h
:* 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 regime: Penicillin G 2 MU IV/IM q4h {{or}} Ampicillin 2 g IV q6h
2. '''Streptococcus pyogenes'''
 
:* Preferred regimen (1): [[Penicillin G]] 2 MU IV/IM q4h
:* Alternative regime: Clindamycin 600–1200 mg/day IV/IM q6–12h {{or}} Cefazolin 0.25–1 g IV/IM q6–8h
:* 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)
  • 2. Staphylococcus aureus, methicillin-resistant (MRSA)
  • 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
  • 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
  • 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 (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

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 (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 (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 (3): Vancomycin 15–20 mg/kg IV q8–12h (trough: 10–20 mg/L)
  • 3. High Risk for Pseudomonas aeruginosa
  • 4. Polymicrobial Infection

Osteomyelitis, foot bone

  • Foot bone osteomyelitis due to nail through tennis shoe [6]
  • 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
  • 2. Gm-neg. bacilli

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
  • 1.2.2 MRSA unlikely
  • 1.3 Newborn (<4 mos.)
  • 1.3.1 MRSA possible
  • 1.3.2 MRSA unlikely
  • 2. Specific therapy
  • 2.1 MSSA
  • 2.2 MRSA

Osteomyelitis, hemoglobinopathy

  • Osteomyelitis, hemoglobinopathy [9]

Osteomyelitis, spinal implant

  • Culture, treat & then suppress until fusion occurs
  • Main parenteral antimicrobial therapy
  • Suppressive antimicrobial therapy strategy
  • 2. Onset after 30 days
  • Remove implant, culture & treat
  • Main parenteral antimicrobial therapy
  • Suppressive antimicrobial therapy strategy

Osteomyelitis, vertebral

  • Vertebral Osteomyelitis – Pathogen-Based Therapy [12] [13]
  • 1. OSSA or coagulase-negative staphylococci
  • 2. ORSA
  • 3. Streptococcus
  • 4. Enterobacteriaceae, quinolone-susceptible
  • 5. Enterobacteriaceae, quinolone-resistant
  • Preferred regimen: Imipenem 500 mg IV q6h
  • 6. Pseudomonas aeruginosa
  • 7. Anaerobes
  • 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 (4): Azithromycin 500 mg PO single dose THEN 250 mg PO qd for 4 days
  • 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

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]

Septic arthritis, candidal

  • Septic arthritis, candidal [2]
  • Preferred regimen (1): Fluconazole 400 mg/day (6 mg/kg/day) for at least 6 weeks
  • Alternative regimen (2): Caspofungin 70-mg loading dose THEN 50 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 (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 (2): Cefepime 2 g IV q8–12h
  • Alternative regimen (2): Imipenem 500 mg IV q6h
  • Alternative regimen (3): Meropenem 1 g IV q8h
  • Alternative regimen (4): Doripenem 500 mg IV q8h

Septic arthritis, Histoplasmosis

  • Septic arthritis, histoplasmosis[21]
  • 1. Mild disease
  • 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
  • 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
  • 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
  • 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.
  • 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):
  • One hepatotoxic drug:
  • No hepatotoxic drugs:
  • 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
  • Preferred regimen (2): Oxacillin 2 g IV q4–6h
  • Alternative regimen (1): Cefazolin 1–2 g IV q8h
  • 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
  • Initial parenteral therapy plus Rifampin followed by prolonged oral therapy is recommended.
  • 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)
  • 2.3 Streptococci, beta-hemolytic
  • Preferred regimen (1): Penicillin 12–18 MU/day 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)
  • 2.5 Gram-negative bacilli
  • Patients susceptible to fluoroquinolones
  • 2.5.1 P. aeruginosa
  • Preferred regimen (1): Cefepime 2 g IV q12h
  • 2.6 Anaerobes
  • 2.6.1Propionibacterium acnes
  • Preferred regimen (1): Penicillin 24 MU/day IV q4h or continuously
  • 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

Septic arthritis, staphylococcal

  • 1.Staphylococcus aureus (methicillin-resistant)[26][27]
  • 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 (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

  1. ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
  2. ↑ 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.
  3. ↑ Spellberg B, Lipsky BA (2012). "Systemic antibiotic therapy for chronic osteomyelitis in adults". Clin Infect Dis. 54 (3): 393–407. doi:10.1093/cid/cir842. PMC 3491855. PMID 22157324.
  4. ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
  5. ↑ 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.
  6. ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
  7. ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
  8. ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
  9. ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
  10. ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
  11. ↑ 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.
  12. ↑ Gentry LO (1991). "Oral antimicrobial therapy for osteomyelitis". Ann Intern Med. 114 (11): 986–7. PMID 2024868.
  13. ↑ Marschall J, Bhavan KP, Olsen MA, Fraser VJ, Wright NM, Warren DK (2011). "The impact of prebiopsy antibiotics on pathogen recovery in hematogenous vertebral osteomyelitis". Clin Infect Dis. 52 (7): 867–72. doi:10.1093/cid/cir062. PMC 3106232. PMID 21427393.
  14. ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
  15. ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
  16. ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
  17. ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
  18. ↑ Corbel, Michael (2006). Brucellosis in humans and animals. Geneva: World Health Organization. ISBN 9241547138.
  19. ↑ Shirtliff ME, Mader JT (2002). "Acute septic arthritis". Clin Microbiol Rev. 15 (4): 527–44. PMC 126863. PMID 12364368.
  20. ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
  21. ↑ 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.
  22. ↑ 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.
  23. ↑ 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.
  24. ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
  25. ↑ 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.
  26. ↑ 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.
  27. ↑ 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.
  28. ↑ "Clinical Management of Septic Arthritis" (PDF).
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