Vertebral Osteomyelitis (No Hardware in Place)

Diagnosis Common Pathogens Drug(s) of First Choice Alternative Drug(s) Comments Expected Duration
Vertebral osteomyelitis without epidural abscess (no hardware in place)

S. aureus

Streptococci (anaerobic or aerobic)

E.coli

If patient is stable, has negative blood cultures, and is without epidural abscess, withhold antibiotics until bone biopsy and consult ID

Ceftriaxone 2g IV q24h

PLUS

Vancomycin

If patient is stable, has negative blood cultures, and is without epidural abscess, withhold antibiotics until bone biopsy and consult ID

For severe PCN allergy:

Aztreonam 2g IV q8h

PLUS

Vancomycin
  ID consultation recommended
Vertebral osteomyelitis with epidural abscess (no hardware in place)   See Epidural Abscess     ID consultation recommended

2015 Infectious Diseases Society of America (IDSA) Clinical Practice Guidelines for the Diagnosis and Treatment of Native Vertebral Osteomyelitis in Adults. Clinical Infectious Diseases, Volume 61, Issue 6, 15 September 2015, Pages e26–e46, https://doi.org/10.1093/cid/civ482