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Hospitalized patients

Infection		Organisms	First DOC	Alternative
Osteomyelitis	Presumed hematogenous source or contiguous without vascular insufficiency	S. aureus	Vancomycin	Vanc	If S. aureus is methicillin-susceptible then cefazolin 2 g IV q8h or nafcillin 2 g IV q4h are the antibiotics of choice. Obtain bone biopsy to determine microbiologic cause prior to initiation of antimicrobial therapy if blood cultures are negative and patient clinically stable.
	With vascular insufficiency or diabetes mellitus (e.g. severe diabetic foot ulcer)	S. aureus  Enterobacteriaceae Anaerobes	Vancomycin PLUS ONE OF: Piperacillin/TazobactamID-R: SFGH 4.5 g IV q6-8h OR Ertapenem 1 g IV daily	For severe PCN allergy: Vancomycin PLUS ONE OF: CiprofloxacinID-R: VASF 400 mg IV q12h OR Levofloxacin ID-R: VASF 750 mg IV daily OR Aztreonam ID-R: SFGH 2 g IV q8h ALL WITH OR WITHOUT: Metronidazole500 mg IV q8h (if patient critically ill)	Other organisms are possible, esp. with hardware microbiologic diagnosis and ID consultation recommended Obtain bone biopsy to determine microbiologic cause prior to initiation of antimicrobial therapy if patient clinically stable Once stable, switch to oral antibiotics based on susceptibility results.
Septic Arthritis		S. aureus Streptococci spp. N. gonorrhoeae Enterobacteriaceae (rarely)	Vancomycin PLUS Ceftriaxone1 g IV daily	For severe PCN allergy: Vancomycin PLUS ONE OF: CiprofloxacinID-R: VASF 400 mg IV q12h OR Levofloxacin ID-R: VASF 500 mg IV daily OR AztreonamID-R: SFGH 2 g IV q8h if gonococcus is strongly suspected	Gram stain recommended to guide therapy. Narrow coverage to microbiologically confirmed pathogens.