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Doses provided in this table are for patients with normal renal and hepatic function. Click on drug link to go to dosing guidelines. Some antimicrobials are restricted (ID-R). Click on link for guidelines on obtaining authorization.
| Diagnosis | Common Pathogens | Drug(s) of First Choice | Alternative Drug(s) | Comments | Expected Duration |
|---|---|---|---|---|---|
|
Non-vertebral osteomyelitis |
S. aureus |
If patient is stable and has negative blood cultures, withhold antibiotics until bone biopsy and consult ID |
N/A |
If S. aureus is methicillin-susceptible then cefazolin 2g IV q8h or nafcillin 2g IV q4h are the antibiotics of choice |
ID consultation recommended |
|
Non-vertebral osteomyelitis with vascular insufficiency or Diabetes Mellitus (e.g. severe diabetic foot ulcer) |
S. aureus Enterobacteriaceae Anaerobes P. aeruginosa (rare without risk factors, see comments) |
Obtain bone biopsy to determine microbiologic cause prior to initiation of antimicrobial therapy if patient clinically stable and has negative blood cultures PLUS |
Obtain bone biopsy to determine microbiologic cause prior to initiation of antimicrobial therapy if patient clinically stable and has negative blood cultures For severe PCN allergy: Vancomycin PLUS ONE OF: OR WITH Metronidazole (if patient critically ill) |
Consider Pseudomonal coverage with Piperacillin-Tazobactam or Cefepime in patients with the following risk factors:
Include anaerobic coverage with piperacillin-tazobactam in necrotic or gas forming infections (see SSTI guidance for NSTI management) Other organisms are possible, esp. with hardware-microbiologic diagnosis and ID consultation recommended Once stable, switch to oral antibiotics based on susceptibility results |
ID consultation recommended |