Sandbox/osteo

Hematogenous Osteomyelitis

▸ Click on the following categories to expand treatment regimens.

Age

▸ Newborn (<4 months)

▸ Children (>4 months) - Adults

▸ Adult (>21 years)

Staph aureus, gram-negative bacilli, group B strept
Preferred Regimen
▸ Vancomycin 40 mg divided q6-8 hours
PLUS
▸ Ceftazidime 50 mg IV q8h OR ▸ Cefepime 150 mg IV q8h
Alternative Regimen
▸ Nafcillin OR ▸ Oxcacillin 37 mg q6h
PLUS
▸ Ceftazidime 2 gm IV q8h OR Cefepime 2 gm IV q12h

Staph aureus, group A strept, gram-negative bacilli
Preferred Regimen
▸ Vancomycin 40 mg divided q6-8 hours
PLUS
▸ Ceftazidime 50 mg IV q8h OR ▸ Cefepime 150 mg IV q8h
Alternative Regimen
▸ Nafcillin OR ▸ Oxcacillin 37 mg q6h
PLUS
▸ Ceftazidime 2 gm IV q8h OR Cefepime 2 gm IV q12h

Staph aureus (most common)
Preferred Regimen
▸ Vancomycin 1 gm IV q12h, if over 100 kg, 1.5 gm IV q12h
Alternative Regimen
▸ Nafcillin 2 gm IV q4h OR ▸ Oxacillin 2 gm IV q4h

▸ Click on the following categories to expand treatment regimens.

Specific Etiology

▸ Methicillin-sensitive S.aureus

▸ Methicillin-resistant S.aureus

▸ Salmonella; GN bacilli

MSSA
Preferred Regimen
▸ Nafcillin 2 gm IV q4h OR ▸ Oxacillin 2 gm IV q4h OR ▸ Cefazolin IV q8h
Alternative Regimen
▸ Vancomycin 1 gm q12h IV; if over 100 kg, 1.5 gm IV q12h

MRSA
Preferred Regimen
▸ Vancomycin 1 gm q12h IV
Alternative Regimen
▸ Linezolid 600 mg q12h IV/po ± ▸ Rifampin 300 mg po/IV bid

Salmonella (Gram-negative bacilli)
Preferred Regimen
▸ Ciprofloxacin 400 mg IV q12h
Alternative Regimen
▸ *Levofloxacin 750 mg IV q24h*