Bone and joint antibiotics

Diabetic foot infection

Associated organisms include Staphylococcus, Streptococcus, Enterococcus, Enterobacteriaceae, Proteus, Bacteroides, and Pseudomonas, and Klebsiella

Superficial Mild Infections

• Clindamycin 450mg PO q8hrs daily x 14 days OR
• TMP/SMX 2DS tabs PO q12hrs daily x 14 days OR
• Doxycycline 100mg PO q12hrs daily x 14 days

Prior antibiotic treatment or moderate infections

• Amoxicillin/Clavulanate 875/125mg PO q12hrs + TMP/SMX 2DS tabs PO q12hrs daily x 14 days OR
• Clindamycin 450mg PO q8hrs + Ciprofloxacin 750mg PO q12hrs x 14 days

Inpatient Treatment

• Vancomycin 15-20mg/kg IV q12hrs plus
  • Ampicillin/Sulbactam 3g IV q6hrs OR
  • Piperacillin/Tazobactam 4.5g IV q8hrs OR
  • Ticarcillin/Clavulanate 3.1g IV q8hrs OR
  • Imipenem 500mg IV q6hrs OR
  • Metronidazole 500mg IV q8hrs PLUS
    • Cefepime 2g IV q12hrs OR
    • Ciprofloxacin 400mg IV q12hrs OR
    • Aztreonam 2g IV q8hrs

Diskitis or Osteomyelitis

• Treatment targets S. aureus, Streptococcus, Pseudomonas, E. coli

Inpatient Therapy

• Vancomycin 15-20 mg/kg IV BID PLUS any of the following:
  • Ceftriaxone 2g IV daily
  • Cefepime 2g IV IV three times daily
  • Ceftazidime 2g IV three times daily
  • Ciprofloxacin 400mg IV three times daily

Felon

Definitive treatment is drainage but antibiotic coverage for S. aureus and Strep with caution to identify Herpetic whitlow

• Cephalexin 500mg PO q6hrs daily x 7 days
• TMP/SMX 2 DS tablets PO q12hrs x 7 days
• Clindamycin 450mg PO q8hrs x 7 days
• Dicloxacillin 250mg PO q6hrs daily x 7 days

Infectious Tenosynovitis

Treatment should cover S. aureus, Streptococcus, and MRSA

• Vancomycin 15-20 mg/kg once daily OR
• Levofloxacin 750 mg IV once daily (avoid in pediatrics)
• If suspicious of Gonococcal infection then 1g IV once daily

Animal Bites

Ampicillin/Sulbactam 3g (50mg/kg) IV four times daily

Pediatrics

• Ceftriaxone 100mg/kg IV once daily AND Metronidazole 7.5mg/kg IV four times daily OR
• Clindamycin 10mg/kg IV four times daily NA TMP/SMX 5mg/kg IV BID

Open fracture

• NNT 12.5 to prevent early fracture site infection

Grade I Fracture Options

• Cefazolin (Ancef) 2g IV three times daily
• Ciprofloxacin 400mg IV BID (avoid in pediatrics)

Grade II/III Fracture Options

• Add Gentamicin 300 mg (1-1.7mg/kg) IV to any of the Grade I regemins
• If concern for Clostridium then consider single drug regimen of Pipericillin/Tazobactam 4.5g (80mg/kg) IV three times daily

Osteomyelitis

Risk Factor	Likely Organism	Initial Empiric Antibiotic Therapy'
Elderly, hematogenous spread	MRSA, MSSA, gram neg	Vancomycin 1gm + (Piperacillin/Tazobactam 3.375 grams OR imipenem 500mg)
Sickle Cell Disease	Salmonella, gram-negative bacteria	Ceftriaxone 50mg/kg IV once daily OR Cefotaxime 50mg/kg IV three times daily, PLUS Vancomycin 15mg/kg IV four times daily OR Clindamycin 10mg/kg IV PO four times daily OR Nafcillin 50 mg/kg IV four times daily to cover K. Kingae (common in daycare population)
DM or vascular insufficiency	Polymicrobial: Staph, strep, coliforms, anaerobes	Vancomycin 1gm + (Piperacillin/Tazobactam 3.375 grams OR imipenem 500mg)
IV drug user	MRSA, MSSA, pseudomonas	Vancomycin 1gm
Newborn	MRSA, MSSA, GBS, Gram Negative	Vancomycin 15mg/kg load, then reduce dose, AND ceftazidime 30mg/kg IV q12 h
Children	MRSA, MSSA	Vancomycin 10mg/kg q6 h AND ceftazidime 50mg/kg q8hr
Postoperative (ortho)	MRSA, MSSA	Vancomycin 1gm
Human bite	Strep, anaerobes, HACEK organism	Piperacillin/Tazobactam 3.375gm OR imipenem 500mg
Animal bite	Pasteurella, Eikenella, HACEK organism	Piperacillin/Tazobactam 3.375gm OR imipenem 500mg

Septic Arthritis

For adults treatment should be divided into Gonococcal and Non-Gonococcal

Gonococcal

• Ceftriaxone 1g IV once daily
• Cefixime 400 mg PO BID is an option for outpatient therapy after initial 3 days of Ceftriaxone

Non-Gonococcal

• Treatment should cover S. aureus, Streptococcus, Pseudomonas, Enterococcus, B. burgdorferi
• Vancomycin 15-20 mg/kg IV BID PLUS any of the following:
  • Ceftriaxone 2g IV once daily
  • Cefepime 2g IV three times daily
  • Ceftazidime 2g IV three times daily
  • Ciprofloxacin 400mg IV three times daily

Pediatrics

• Ceftriaxone 1g IV once daily

Septic Bursitis

• Cover Staphylococcus aureus Streptococcus (including MRSA)

Outpatient Options

• Clindamycin 300 mg PO three times daily x 10 days
• TMP/SMX 2 DS tabs PO two times daily x 10 days
• Dicloxacillin 500mg q6hr x10 days

Inpatient Options

• Vancomycin 15-20 mg/kg IV BID
• Clindamycin 600 mg IV three times daily

Antibiotics by diagnosis

• Bone and joint antibiotics
• Cardiovascular antibiotics
• ENT antibiotics
• Eye antibiotics
• GI antibiotics
• GU antibiotics
• Neuro antibiotics
• OB/GYN antibiotics
• Pulmonary antibiotics
• Skin and soft tissue antibiotics
• Bioterrorism antibiotics
• Environmental exposure antibiotics
• Immunocompromised antibiotics
• Post exposure prophylaxis antibiotics
• Pediatric antibiotics
• Sepsis antibiotics
• Arthropod and parasitic antibiotics

For antibiotics by organism see Microbiology (Main)

References

Authors

Ross Donaldson, Daniel Ostermayer