Sandbox ID Musculoskeletal: Difference between revisions
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===Osteomyelitis, chronic=== | ===Osteomyelitis, chronic=== | ||
*1. Chronic Osteomyelitis in Adults – Pathogen-Based Therapy <ref name="pmid22157324">{{cite journal| author=Spellberg B, Lipsky BA| title=Systemic antibiotic therapy for chronic osteomyelitis in adults. | journal=Clin Infect Dis | year= 2012 | volume= 54 | issue= 3 | pages= 393-407 | pmid=22157324 | doi=10.1093/cid/cir842 | pmc=PMC3491855 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22157324 }} </ref> | *1. '''Chronic Osteomyelitis in Adults – Pathogen-Based Therapy''' <ref name="pmid22157324">{{cite journal| author=Spellberg B, Lipsky BA| title=Systemic antibiotic therapy for chronic osteomyelitis in adults. | journal=Clin Infect Dis | year= 2012 | volume= 54 | issue= 3 | pages= 393-407 | pmid=22157324 | doi=10.1093/cid/cir842 | pmc=PMC3491855 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22157324 }} </ref> | ||
<ref name=Uptodate>{{cite web | url =http://www.uptodate.com/contents/search?search=chronic+osteomyelitis&sp=0&searchType=PLAIN_TEXT&source=USER_INPUT&searchControl=TOP_PULLDOWN&searchOffset= }}</ref> | <ref name=Uptodate>{{cite web | url =http://www.uptodate.com/contents/search?search=chronic+osteomyelitis&sp=0&searchType=PLAIN_TEXT&source=USER_INPUT&searchControl=TOP_PULLDOWN&searchOffset= }}</ref> | ||
:*1.1 OSSA | :*1.1 '''OSSA''' | ||
::* Preferred regimen: [[Oxacillin]] 1.5–2 g IV q4h for 4–6 | ::* Preferred regimen (1): [[Oxacillin]] 1.5–2 g IV q4h for 4–6 weeks | ||
::* Alternative regimen (1): [[Vancomycin]] 15 mg/kg IV q12h for 4–6 | |||
::* Alternative regimen (2): [[Oxacillin]] 1.5–2 g IV q4h for 4–6 | ::* Preferred regimen (2): [[Cefazolin]] 1–2 g IV q8h for 4–6 weeks | ||
:*1.2 ORSA | ::* Alternative regimen (1): [[Vancomycin]] 15 mg/kg IV q12h for 4–6 weeks | ||
::* Preferred regimen: [[Vancomycin]] 15 mg/kg IV q12h for 4–6 | ::* Alternative regimen (2): [[Oxacillin]] 1.5–2 g IV q4h for 4–6 weeks {{and}} [[Rifampin]] 600 mg PO qd | ||
::* Alternative regimen (1): [[Linezolid]] 600 mg PO/IV q12h for 6 | :*1.2 '''ORSA''' | ||
::* Alternative regimen (2): [[Levofloxacin]] 500–750 mg PO/IV | ::* Preferred regimen (1): [[Vancomycin]] 15 mg/kg IV q12h for 4–6 weeks | ||
::* Preferred regimen (2): [[Daptomycin]] 6 mg/kg IV q24h | |||
::* Alternative regimen (1): [[Linezolid]] 600 mg PO/IV q12h for 6 weeks {{withorwithout}} [[Rifampin]] 600–900 mg PO qd | |||
::* Alternative regimen (2): [[Levofloxacin]] 500–750 mg/day PO/IV {{withorwithout}} [[Rifampin]] 600–900 mg PO qd | |||
:*1.3 Penicillin-sensitive Streptococcus | :*1.3 Penicillin-sensitive Streptococcus | ||
::* Preferred regimen: [[Penicillin G]] 20 MU/day IV continuously or q4h for 4–6 | ::* Preferred regimen: [[Penicillin G]] 20 MU/day IV continuously or q4h for 4–6 weeks {{or}} [[Ceftriaxone]] 1–2 g IV/IM q24h for 4–6 weeks {{or}} [[Cefazolin]] 1–2 g IV q8h for 4–6 weeks | ||
::* Alternative regimen: [[Vancomycin]] 15 mg/kg IV q12h for 4–6 | ::* Alternative regimen: [[Vancomycin]] 15 mg/kg IV q12h for 4–6 weeks | ||
:*1.4 Enterococcus or Streptococcus (MIC≥0.5 μg/mL) or Abiotrophia or Granulicatella | :*1.4 Enterococcus or Streptococcus (MIC≥0.5 μg/mL) or Abiotrophia or Granulicatella | ||
::* Preferred regimen: [[Penicillin G]] 20 MU/day IV continuously or q4h for 4–6 | ::* Preferred regimen: [[Penicillin G]] 20 MU/day IV continuously or q4h for 4–6 weeks {{withorwithout}} [[Gentamicin]] 1 mg/kg IV/IM q8h for 1–2 weeks {{or}} [[Ampicillin]] 12 g/day IV continuously or q4h for 4–6 weeks {{withorwithout}} [[Gentamicin]] 1 mg/kg IV/IM q8h for 1–2 weeks | ||
::* Alternative regimen: [[Vancomycin]] 15 mg/kg IV q12h for 4–6 | ::* Alternative regimen: [[Vancomycin]] 15 mg/kg IV q12h for 4–6 weeks {{withorwithout}} [[Gentamicin]] 1 mg/kg IV/IM q8h for 1–2 weeks | ||
:*1.5 Enterobacteriaceae | :*1.5 Enterobacteriaceae | ||
::* Preferred regimen: [[Ceftriaxone]] 1–2 g IV/IM q24h for 4–6 | ::* Preferred regimen: [[Ceftriaxone]] 1–2 g IV/IM q24h for 4–6 weeks {{or}} [[Ertapenem]] 1 g IV q24h | ||
::* Alternative regimen: [[Levofloxacin]] 500–750 mg PO q24h {{or}} [[Ciprofloxacin]] 500–750 mg PO q12h for 4–6 | ::* Alternative regimen: [[Levofloxacin]] 500–750 mg PO q24h {{or}} [[Ciprofloxacin]] 500–750 mg PO q12h for 4–6 weeks | ||
:*1.6 Pseudomonas aeruginosa | :*1.6 Pseudomonas aeruginosa | ||
::* Preferred regimen: [[Cefepime]] 2 g IV q12h {{or}} [[Meropenem]] 1 g IV q8h {{or}} [[Imipenem]] 500 mg IV q6h for 4–6 | ::* Preferred regimen: [[Cefepime]] 2 g IV q12h {{or}} [[Meropenem]] 1 g IV q8h {{or}} [[Imipenem]] 500 mg IV q6h for 4–6 weeks | ||
::* Alternative regimen: [[Ciprofloxacin]] 750 mg PO q12h {{or}} [[Ceftazidime]] 2 g IV q8h for 4–6 | ::* Alternative regimen: [[Ciprofloxacin]] 750 mg PO q12h {{or}} [[Ceftazidime]] 2 g IV q8h for 4–6 weeks | ||
*2. Chronic Osteomyelitis in Children – Pathogen-Based Therapy | *2. Chronic Osteomyelitis in Children – Pathogen-Based Therapy | ||
:* ''Group A beta-hemolytic Streptococcus, Haemophilus influenzae type B and Streptococcus pneumoniae'' | :* ''Group A beta-hemolytic Streptococcus, Haemophilus influenzae type B and Streptococcus pneumoniae'' | ||
Revision as of 15:29, 30 July 2015
Bursitis
- Olecranon bursitis or prepatellar bursitis [1]
- 1. Staphylococcus aureus, methicillin-susceptible (MSSA)
- Preferred regimen (1): Nafcillin 2 g IV q4h
- Preferred regimen (2): Oxacillin 2 g IV q4h
- Preferred regimen (3): Dicloxacillin 500 mg PO qid
- 2. Staphylococcus aureus, methicillin-resistant (MRSA)
- Preferred regimen (1): Vancomycin 1 g IV q12h
- Preferred regimen (2): Linezolid 600 mg PO qd
Osteomyelitis, candidal
- Osteomyelitis, candidal [2]
- Preferred regimen (1): Fluconazole 400 mg/day (6 mg/kg/day) PO for 6–12 months
- Preferred regimen (2): Amphotericin B 3–5 mg/kg/day PO for several weeks THEN Fluconazole for 6–12 months
- Alternative regimen (1): Anidulafungin 200 mg loading dose THEN 100 mg/day PO
- Alternative regimen (2): Caspofungin 70mg loading dose THEN 50 mg/day PO
- Alternative regimen (3): Micafungin 100 mg/day PO
- Alternative regimen (4): Amphotericin B deoxycholate 0.5–1 mg/kg/day PO for several weeks THEN Fluconazole for 6–12 months
- Note: Duration of therapy usually is prolonged (6–12 months); Surgical debridement is frequently necessary
Osteomyelitis, chronic
- 1. Chronic Osteomyelitis in Adults – Pathogen-Based Therapy [3]
- 1.1 OSSA
- Preferred regimen (1): Oxacillin 1.5–2 g IV q4h for 4–6 weeks
- Preferred regimen (2): Cefazolin 1–2 g IV q8h for 4–6 weeks
- Alternative regimen (1): Vancomycin 15 mg/kg IV q12h for 4–6 weeks
- Alternative regimen (2): Oxacillin 1.5–2 g IV q4h for 4–6 weeks AND Rifampin 600 mg PO qd
- 1.2 ORSA
- Preferred regimen (1): Vancomycin 15 mg/kg IV q12h for 4–6 weeks
- Preferred regimen (2): Daptomycin 6 mg/kg IV q24h
- Alternative regimen (1): Linezolid 600 mg PO/IV q12h for 6 weeks ± Rifampin 600–900 mg PO qd
- Alternative regimen (2): Levofloxacin 500–750 mg/day PO/IV ± Rifampin 600–900 mg PO qd
- 1.3 Penicillin-sensitive Streptococcus
- Preferred regimen: Penicillin G 20 MU/day IV continuously or q4h for 4–6 weeks OR Ceftriaxone 1–2 g IV/IM q24h for 4–6 weeks OR Cefazolin 1–2 g IV q8h for 4–6 weeks
- Alternative regimen: Vancomycin 15 mg/kg IV q12h for 4–6 weeks
- 1.4 Enterococcus or Streptococcus (MIC≥0.5 μg/mL) or Abiotrophia or Granulicatella
- Preferred regimen: Penicillin G 20 MU/day IV continuously or q4h for 4–6 weeks ± Gentamicin 1 mg/kg IV/IM q8h for 1–2 weeks OR Ampicillin 12 g/day IV continuously or q4h for 4–6 weeks ± Gentamicin 1 mg/kg IV/IM q8h for 1–2 weeks
- Alternative regimen: Vancomycin 15 mg/kg IV q12h for 4–6 weeks ± Gentamicin 1 mg/kg IV/IM q8h for 1–2 weeks
- 1.5 Enterobacteriaceae
- Preferred regimen: Ceftriaxone 1–2 g IV/IM q24h for 4–6 weeks OR Ertapenem 1 g IV q24h
- Alternative regimen: Levofloxacin 500–750 mg PO q24h OR Ciprofloxacin 500–750 mg PO q12h for 4–6 weeks
- 1.6 Pseudomonas aeruginosa
- Preferred regimen: Cefepime 2 g IV q12h OR Meropenem 1 g IV q8h OR Imipenem 500 mg IV q6h for 4–6 weeks
- Alternative regimen: Ciprofloxacin 750 mg PO q12h OR Ceftazidime 2 g IV q8h for 4–6 weeks
- 2. Chronic Osteomyelitis in Children – Pathogen-Based Therapy
- Group A beta-hemolytic Streptococcus, Haemophilus influenzae type B and Streptococcus pneumoniae
- Preferred regimen: Ampicillin 150–200 mg/kg/day administered in 4 equal doses OR Amoxicillin 150–200 mg/kg/day administered in 4 equal doses
- Alternative regimen: Chloramphenicol 75 mg/kg/day administered in 3 equal doses
Osteomyelitis, contiguous with vascular insufficiency
- Osteomyelitis, contiguous with vascular insufficiency [5]
- Note (1): Debride overlying ulcer and send bone specimen for histology and culture.
- Note (2): No empiric antimicrobial therapy unless acutely ill.
- Note (3): Antibiotic therapy should be based on culture results and treat for 6 weeks.
- Note (4): Revascularize if possible.
Osteomyelitis, diabetic foot
- 1. Chronic Infection or Recent Antibiotic Use [6]
- Preferred regimen: Levofloxacin 750 mg IV/PO q24h OR Cefoxitin 1 g IV q4h (or 2 g IV q6–8h) OR Ceftriaxone 1–2 g/day IV/IM q12–24h OR Ampicillin–Sulbactam 1.5–3 g IV/IM q6h OR Moxifloxacin 400 mg IV/PO q24h OR Ertapenem 1 g IV/IM q24h OR Tigecycline 100 mg IV, then 50 mg IV q12h (active against MRSA) OR Imipenem–Cilastatin 0.5–1 g IV q6–8h (Not active against MRSA; consider when ESBL-producing pathogens suspected)
- Alternative regimen (1): Levofloxacin 750 mg IV/PO q24h AND Clindamycin 150–300 mg PO qid
- Alternative regimen (2): Ciprofloxacin 600–1200 mg/day IV q6–12h AND Clindamycin 150–300 mg PO qid
- Alternative regimen (3): Ciprofloxacin 1200–2700 mg IV q6–12h (for more severe cases) AND Clindamycin 150–300 mg PO qid
- 2. High Risk for MRSA
- Preferred regimen: Linezolid 600 mg IV/PO q12h OR Daptomycin 4 mg/kg IV q24h OR Vancomycin 15–20 mg/kg IV q8–12h (trough: 10–20 mg/L)
- 3. High Risk for Pseudomonas aeruginosa
- Preferred regimen: Piperacillin–Tazobactam 3.375 g IV q6–8h
- 4. Polymicrobial Infection
- Preferred regimen: (Vancomycin 15–20 mg/kg IV q8–12h (trough: 10–20 mg/L) OR Linezolid 600 mg IV/PO q12h OR Daptomycin 4 mg/kg IV q24h) AND (Piperacillin–Tazobactam 3.375 g IV q6–8h OR Imipenem–Cilastatin 0.5–1 g IV q6–8h OR Ertapenem 1 g IV/IM q24h OR Meropenem 1 g IV q8h)
- Alternative regimen: (Vancomycin 15–20 mg/kg IV q8–12h (trough: 10–20 mg/L) OR Linezolid 600 mg IV/PO q12h OR Daptomycin 4 mg/kg IV q24h) AND (Ceftazidime 2 g IV q8h OR Cefepime 2 g IV q8h OR Aztreonam 2 g IV q6–8h) AND Metronidazole 15 mg/kg IV, then 7.5 mg/kg IV q6h
Osteomyelitis, foot bone
- Foot bone osteomyelitis due to nail through tennis shoe [7]
- Preferred regimen: Ciprofloxacin 750 mg po bid OR Levofloxacin 750 mg po q24h
- Alternative regimen: Ceftazidime 2 g IV q8h OR Cefepime 2 g IV q12h
Osteomyelitis, foot puncture wound
- Long bone, post-internal fixation of fracture [8]
- Preferred regimen: Vancomycin 1 g IV q12h AND (Ceftazidime OR Cefepime)
- Alternative regimen (1): Linezolid 600 mg IV/po bidNAI AND Ceftazidime
- Alternative regimen (2): Linezolid 600 mg IV/po bidNAI AND Cefepime
- Note: If susceptible Gm-neg. bacillus, Ciprofloxacin 750 mg po bid OR Levofloxacin 750 mg po qd
Osteomyelitis, hematogenous
- 1. Empiric therapy [9]
- 1.1 Adult (>21 yrs)
- 1.1.1 MRSA possible
- Preferred regimen: Vancomycin 1 g IV q12h (if over 100 kg, 1.5 g IV q12h)
- 1.1.2 MRSA unlikely
- 1.2 Children (>4 mos.)-Adult
- 1.2.1 MRSA possible
- Preferred regimen: Vancomycin 40 div q6–8h
- 1.2.2 MRSA unlikely
- Note: Add Ceftazidime 50 q8h or Cefepime 150 div q8h if Gm-neg. bacilli on Gram stain
- 1.3 Newborn (<4 mos.)
- 1.3.1 MRSA possible
- Preferred regimen: Vancomycin AND (Ceftazidime 2 g IV q8h or Cefepime 2 g IV q12h)
- 1.3.2 MRSA unlikely
- Preferred regimen: (Nafcillin OR Oxacillin) AND (Ceftazidime OR Cefepime)
- 2. Specific therapy
- 2.1 MSSA
- Preferred regimen: Nafcillin OR Oxacillin 2 g IV q4h OR Cefazolin 2 g IV q8h
- Alternative regimen: Vancomycin 1 g IV q12h (if over 100 kg, 1.5 g IV q12h)
- 2.2 MRSA
- Preferred regimen: Vancomycin 1 g IV q12h
- Alternative regimen: Linezolid 600 mg q12h IV/po ± Rifampin 300 mg po/IV bid
Osteomyelitis, hemoglobinopathy
- Osteomyelitis, hemoglobinopathy [10]
- Preferred regimen: Ciprofloxacin 400 mg IV q12h
- Alternative regimen: Levofloxacin 750 mg IV q24h
Osteomyelitis, spinal implant
- 1. Onset within 30 days [11]
- Preferred regimen: Culture, treat & then suppress until fusion occurs
- 2. Onset after 30 days
- Preferred regimen: Remove implant, culture & treat
Osteomyelitis, vertebral
- 1. OSSA or coagulase-negative staphylococci
- Preferred regimen: Oxacillin 2 g IV q6h OR Cefazolin 1–2 g IV q8h
- Alternative regimen: Levofloxacin 750 mg PO qd AND Rifampin 300 mg PO bid
- 2. ORSA
- Preferred regimen: Vancomycin 1 g IV q12h
- Alternative regimen (1): Daptomycin ≥ 6 mg/kg IV q24h
- Alternative regimen (2): Levofloxacin 500–750 mg PO/IV daily AND Rifampin 600–900 mg PO qd
- 3. Streptococcus
- Preferred regimen: Penicillin G 5 MU IV q6h
- Alternative regimen: Ceftriaxone 2 g IV q24h
- 4. Enterobacteriaceae, quinolone-susceptible
- Preferred regimen: Ciprofloxacin 750 mg PO q12h
- Alternative regimen: Ceftriaxone 2 g IV q24h
- 5. Enterobacteriaceae, quinolone-resistant
- Preferred regimen: Imipenem 500 mg IV q6h
- 6. Pseudomonas aeruginosa
- Preferred regimen: Cefepime 2 g IV q8h OR Ceftazidime 2 g IV q8h x 2–4 wk, followed by Ciprofloxacin 750 mg PO bid
- Alternative regimen: Piperacillin–Tazobactam 750 mg PO q12h x 2–4 wk, followed by Ciprofloxacin 750 mg PO bid
- 7. Anaerobes
- Preferred regimen: Piperacillin–Tazobactam 750 mg PO q12h x 2–4 wk, followed by Ciprofloxacin 750 mg PO bid
- Alternative regimen (1): Penicillin G 5 MU IV q6h OR Ceftriaxone 2 g IV q24h (against gram-positive anaerobes)
- Alternative regimen (2): Metronidazole 500 mg PO tid (against gram-negative anaerobes)
Osteomyelitis, sternal
- Osteomyelitis, sternal [14]
- Preferred regimen: Vancomycin 1 g IV q12h (If over 100kg, 1.5 g IV q12h)
- Alternative regimen: Linezolid 600 mg po/IVNAI bid
Osteonecrosis of the jaw
- 1. Bacterial Infection [15]
- Preferred regimen: Penicillin VK 500 mg PO q6–8h for 7–10 days (maintenance: 500 mg PO bid) OR Amoxicillin 500 mg PO q8h for 7–10 days (maintenance: 500 mg PO bid)
- Alternative regimen: Clindamycin 150–300 mg PO qid OR Doxycycline 100 mg PO qd OR Erythromycin 400 mg PO tid OR Azithromycin 500 mg PO for 1 dose, then 250 mg PO qd for 4 days OR Levofloxacin 500 mg PO qd OR Moxifloxacin 400 mg PO qd
- 2. Fungal Infection
- Preferred regimen: Nystatin oral suspension 5–15 mL swish qid OR Fluconazole 200 mg PO qd, then 100 mg q24h OR Clotrimazole 10 mg PO tid for 7–10 days
- 3. Viral Infection
- Preferred regimen: Acyclovir 400 mg PO bid OR Valacyclovir 0.5–2.0 g PO bid
Reactive arthritis, post-streptococcal arthritis
- Reactive arthritis, post-streptococcal arthritis [16]
- Preferred regimen: Treat strep pharyngitis and then NSAIDs (Prednisone needed in some patients)
Reactive arthritis, Reiter's syndrome
- Reactive arthritis, Reiter's syndrome [17]
- Preferred regimen: Only treatment is non-steroidal anti-inflammatory drugs
Septic arthritis, Brucella melitensis
- Septic arthritis, Brucella melitensis [18]
- Preferred Regimen: Doxycycline 100 mg PO bid for ≥ 6 weeks AND Streptomycin 15 mg/kg IM qd for 2–3 weeks OR Rifampin 600–900 mg qd for ≥ 6 weeks
- Alternative Regimen: Doxycycline 100 mg PO bid for ≥ 6 weeks AND Gentamicin 5 mg/kg IV qd for 7 days
Septic arthritis, candidal
- Septic arthritis, candidal [2]
- Preferred regimen: Fluconazole 400 mg (6 mg/kg) daily for at least 6 weeks OR lipid formulation of Amphotericin B 3–5 mg/kg daily for several weeks, then Fluconazole to completion
- Alternative regimen: Anidulafungin 200-mg loading dose, then 100 mg/day OR Caspofungin 70-mg loading dose, then 50 mg/day OR Micafungin 100 mg/day OR Amphotericin B deoxycholate 0.5–1 mg/kg daily for several weeks then Fluconazole to completion
- Note: Duration of therapy usually is for at least 6 weeks, but few data are available; Surgical debridement is recommended for all cases; For infected prosthetic joints, removal is recommended for most cases.
Septic arthritis, gonococcal
- Septic arthritis, gonococcal [19]
- Preferred regimen: Ceftriaxone 1 g intramuscularly IM/IV every 24 h
- Alternative regimen: Cefotaxime 1 g IV every 8 hours OR Ceftizoxime 1 g IV every 8 hours
- Note: The tetracyclines (except in pregnant women) or penicillins may be used if the infecting organism is proven to be susceptible; Penicillin allergies should be given Spectinomycin (2 g IV every 12 h);Alternative antibiotics in the β-lactam-allergic patient may be Ciprofloxacin (500 mg IV every 12 h) or Ofloxacin (400 mg IV every 12 h)
- Pediatric regimen: (>45 kg) single daily dose of Ceftriaxone (50 mg/kg and a maximum dose of 2 g, IM or IV) for 10 to 14 days; (<45 kg) Ceftriaxone (50 mg/kg and a maximum dose of 1 g, IM or IV in a single daily dose for 7 days)
Septic arthritis, Gram-negative bacilli
- Septic arthritis, Gram-negative bacilli [20]
- Preferred regimen: Ceftazidime 2 g IV q8h OR Cefepime 2 g IV q8–12h OR Piperacillin-Tazobactam 4.5 g IV q6h
- Alternative regimen: Aztreonam 2 g IV q8h OR Imipenem 500 mg IV q6h OR Meropenem 1 g IV q8h {or}} Doripenem 500 mg IV q8h OR Carbapenems
Septic arthritis, Histoplasmosis
- Septic arthritis, histoplasmosis[21]
- 1. Mild disease
- Preferred regimen: Nonsteroidal anti-inflammatory drug
- 2. Severe disease
- Preferred regimen: Prednisone 0.5–1.0 mg/kg/day (maximum: 80 mg daily) in tapering doses over 1–2 weeks AND Itraconazole 200 mg tid for 3 days, followed by qd or bid for 6–12 weeks
Septic arthritis, Lyme disease
- Septic arthritis, Lyme disease [22]
- 1. Patients without clinical evidence of neurologic disease
- Preferred regimen: Doxycycline 100 mg twice per day OR Amoxicillin 500 mg 3 times per day OR Cefuroxime Axetil 500 mg twice per day for 28 days
- Pediatric regimen: Amoxicillin 50 mg/kg per day in 3 divided doses maximum of 500 mg per dose OR Cefuroxime Axetil 30 mg/kg per day in 2 divided doses maximum of 500 mg per dose OR (if the patient is ≥8 years of age) Doxycycline 4 mg/ kg per day in 2 divided doses (maximum of 100 mg per dose)
- 2. Patients with arthritis and objective evidence of neurologic disease
- Preferred regimen: Ceftriaxone administered parenterally for 2–4 weeks
- Alternative regimen: Cefotaxime OR Penicillin G administered parenterally
- Pediatric regimen: Ceftriaxone OR Cefotaxime OR Penicillin G administered intravenously
- Note (1): For patients who have persistent or recurrent joint swelling after a recommended course of oral antibiotic therapy, we recommend re-treatment with another 4-week course of oral antibiotics or with a 2–4-week course of Ceftriaxone IV
- Note (2): If patients have no resolution of arthritis despite intravenous therapy and if PCR results for a sample of synovial fluid (and synovial tissue if available) are negative, symptomatic treatment is recommended, which consist of nonsteroidal anti-inflammatory agents, intra-articular injections of corticosteroids, or disease-modifying antirheumatic drugs (DMARDs), such as Hydroxychloroquine.
Septic arthritis, Mycobacterium tuberculosis
- Septic arthritis, Mycobacterium tuberculosis[23]
- 1. Septic arthritis caused by susceptible Mycobacterium tuberculosis
- 1.1 Adults
- 1.1.1 Intensive phase
- Preferred regimen: Isoniazid 5 mg/kg (max: 300 mg) for 2 months AND Rifampin 10 mg/kg (max: 600 mg) for 2 months AND Pyrazinamide 15–30 mg/kg (max: 2 g) for 2 months AND Ethambutol 15–20 mg/kg (max: 1 g) for 2 months
- 1.1.2 Continuation phase
- 1.2 Pediatric
- 1.2.1 Intensive phase
- Preferred regimen: Isoniazid 10–15 mg/kg (max: 300 mg) for 2 months AND Rifampin 10–20 mg/kg (max: 600 mg) for 2 months AND Pyrazinamide 15–30 mg/kg (max: 2 g) for 2 months AND Ethambutol 15–20 mg/kg (max: 1 g) for 2 months
- 1.2.2 Continuation phase
- 2. Specific considerations
- 2.1 Pregnancy and breastfeeding
- With the exception of streptomycin, the first line anti-TB drugs are safe for use in pregnancy: Streptomycin is ototoxic to the fetus and should not be used during pregnancy.
- After active TB in the baby is ruled out, the baby should be given 6 months of isoniazid preventive therapy, followed by BCG vaccination.
- Pyridoxine supplementation is recommended for all pregnant or breastfeeding women taking isoniazid.
- 2.2 Liver disorders
- Two hepatotoxic drugs (rather than the three in the standard regimen):
- 9 months of Isoniazid AND Rifampicin AND Ethambutol (until or unless Isoniazid susceptibility is documented).
- 2 months of Isoniazid AND Rifampicin AND Streptomycin AND Ethambutol, followed by 6 months of Isoniazid AND Rifampicin.
- 6–9 months of Rifampicin AND [[Pyrazinamide}} AND Ethambutol.
- One hepatotoxic drug:
- 2 months of Isoniazid AND Ethambutol AND [[Streptomycin}}, followed by 10 months of Isoniazid AND Ethambutol.
- No hepatotoxic drugs:
- 18–24 months of Streptomycin AND Ethambutol AND a Fluoroquinolone.
- 2.3 Renal failure and severe renal insufficiency
- The recommended initial TB treatment regimen for patients with renal failure or severe renal insufficiency is 2 months of isoniazid, rifampicin, pyrazinamide and ethambutol, followed by 4 months of isoniazid and rifampicin.
- There is significant renal excretion of ethambutol and metabolites of pyrazinamide, and doses should therefore be adjusted.
- Three times per week administration of these two drugs at the following doses is recommended: pyrazinamide (25 mg/kg), and ethambutol (15 mg/kg)
- While receiving isoniazid, patients with severe renal insufficiency or failure should also be given pyridoxine in order to prevent peripheral neuropathy.
- Because of an increased risk of nephrotoxicity and ototoxicity, Streptomycin should be avoided in patients with renal failure. If Streptomycin must be used, the dosage is 15 mg/kg, two or three times per week, to a maximum of 1 gram per dose, and serum levels of the drug should be monitored.
- 2.4 Previously treated patients in settings with rapid DST
- TB patients whose treatment has failed or other patient groups with high likelihood of multidrug-resistant TB (MDR) should be started on an empirical MDR regimen.
- TB patients returning after defaulting or relapsing from their first treatment course may receive the retreatment regimen containing first-line drugs 2HRZES/1HRZE/5HRE if country-specific data show low or medium levels of MDR in these patients or if such data are not available.
- 2.5 TB treatment in people living with HIV
- TB patients with known positive HIV status and all TB patients living in HIV prevalent settings should receive daily TB treatment at least during the intensive phase.
- For the continuation phase, the optimal dosing frequency is also daily for these patients.
- If a daily continuation phase is not possible for these patients, three times weekly dosing during the continuation phase is an acceptable alternative.
- It is recommended that TB patients who are living with HIV should receive at least the same duration of TB treatment as HIV-negative TB patients.
Septic arthritis, pneumococcal
Septic arthritis, post-intraarticular injection
- Septic arthritis, post-intraarticular injection [24]
- NO empiric therapy.
Septic arthritis, prosthetic joint infection
- Septic arthritis, prosthetic joint infection (device-related osteoarticular infections) [25]
- 1. Empiric antimicrobial therapy
- It is preferable to delay antibiotic therapy until specimens for culture are obtained by joint aspiration, joint debridement, and/or prosthesis removal.
- 2. Pathogen-directed antimicrobial therapy
- 2.1 Staphylococcus aureus, methicillin-susceptible (MSSA)
- Preferred regimen: Nafcillin 2 g IV q4–6h OR Oxacillin 2 g IV q4–6h
- Alternative regimen: Cefazolin 1–2 g IV q8h OR Ceftriaxone 2 g IV q24h
- Alternative regimen (if allergic to penicillins): Clindamycin 900 mg IV q8h OR Vancomycin 15–20 mg/kg IV q8–12 hours, not to exceed 2 g per dose
- 2.2 Staphylococcus, methicillin-resistant (MRSA)
- 2.2.1 Early-onset (< 2 months after surgery) or acute hematogenous prosthetic joint infections involving a stable implant with short duration (< 3 weeks) of symptoms and debridement (but device retention)
- Preferred regimen: Vancomycin AND Rifampin 600 mg PO qd or 300–450 mg PO bid for 2 weeks
- Alternative regimen: (Daptomycin 6 mg/kg IV q24h OR Linezolid 600 IV q8h) AND Rifampin 600 mg PO qd or 300–450 mg PO bid for 2 weeks
- Note: The above regimen should be followed by Rifampin plus a fluoroquinolone, TMP/SMX, a tetracycline or Clindamycin for 3 or 6 months for hips and knees, respectively.
- 2.2.2 Early-onset spinal implant infections (< 30 days after surgery), or implants in an actively infected site
- 2.3 Streptococci, beta-hemolytic
- Preferred regimen: Penicillin 12–18 MU/day IV q6h OR Ampicillin 2 g IV q6h OR Ceftriaxone 1–2 g IV q24h
- Alternative regimen (allergic to penicillin): Clindamycin 900 mg IV q8h OR Vancomycin 15–20 mg/kg q8–12h, not to exceed 2 g per dose
- 2.4 Enterococci
- 2.4.1 Monotherapy
- Preferred regimen (1): Ampicillin 6 to 12 g per 24 hours in four to six equally divided doses
- Preferred regimen (2): Penicillin G 18 to 30 million units per 24 hours either continuously or in six equally divided doses
- Preferred regimen (3): Vancomycin 15 to 20 mg/kg/dose every 8 to 12 hours, not to exceed 2 g per dose
- 2.4.2 Combination therapy (one of the monotherapy agents, and one of the following agents)
- Preferred regimen (1): Gentamicin 1 mg/kg IV q8h
- Preferred regimen (2): Streptomycin 7.5 mg/kg IV q12h
- Preferred regimen (3): Ampicillin 2 g/day IV q6h AND Ceftriaxone 2 g IV q12h
- 2.5 Gram-negative bacilli
- Patients susceptible to fluoroquinolones
- Preferred regimen: Ciprofloxacin 500 to 750 mg bid
- 2.5.1 P. aeruginosa
- Preferred regimen: Cefepime 2 g intravenously every 12 hours OR Meropenem 1 g intravenously every 8 hours
- Alternative regimen (1): Ciprofloxacin 750 mg orally every 12 hours Ceftazidime 2 g intravenously every 8 hours (alternative)
- Alternative regimen (2): Ceftazidime 2 g intravenously every 8 hours
- 2.6 Anaerobes
- 2.6.1Propionibacterium acnes
- Preferred regimen: Penicillin 24 million units intravenously every 24 hours given in six equally divided doses or as continuous infusion OR Ceftriaxone 1 to 2 g intravenously once daily
- Alternative regimen: Vancomycin OR Clindamycin
- 2.6.2 Not Propionibacterium acnes
- Preferred regimen: Metronidazole 500 mg orally three times a day.
- 2.7 Mycobacterium tuberculosis
- Preferred regimen: see (Septic arthritis, Mycobacterium tuberculosis)
- 2.8 Fungi
- Preferred regimen: see (Septic arthritis, candidal)
- 2.9 Culture negative
- Preferred regimen: Vancomycin AND Ciprofloxacin OR Cefazolin AND Ciprofloxacin
Septic arthritis, staphylococcal
- Preferred regime: Vancomycin 15–20 mg/kg IV q8–12h
- Alternative regimen (1): Daptomycin 6 mg/kg IV q24h in adults
- Alternative regimen (2): Linezolid 600 mg PO/IV q12h
- Alternative regimen (3): Clindamycin 600 mg PO/IV q8h
- Alternative regimen (4): TMP-SMX 3.5–4.0 mg/kg PO/IV q8–12h
- Pediatric regimen: Vancomycin 15 mg/kg IV q6h OR Daptomycin 6–10 mg/kg IV q24h OR Linezolid 10 mg/kg PO/IV q8h OR Clindamycin 10–13 mg/kg/dose PO/IV q6–8h
2. Staphylococcus aureus (methicillin-susceptible)
- Preferred regimen: Nafcillin 2 g IV q6h OR Clindamycin 900 mg IV q8h
- Alternative regimen: Cefazolin 0.25–1 g IV/IM q6–8h OR Vancomycin 500 mg IV q6h or 1 g IV q12h
3. Staphylococcus epidermidis (methicillin-resistant)
- Preferred regimen: Vancomycin 500 mg IV q6h or 1 g IV q12h OR Linezolid 600 mg IV q12h
- Alternative regimen: TMP-SMX 3.5–4.0 mg/kg PO/IV q8–12h (TMP component) OR Minocycline 200 mg PO x 1 dose, then 100 mg PO q12h AND Rifampin 300–600 mg PO/IV q12h
4. Staphylococcus epidermidis (methicillin-susceptible)
- Preferred regimen: Nafcillin 2 g IV q6h OR Clindamycin 900 mg IV q8h
- Alternative regimen: Cefazolin 0.25–1 g IV/IM q6–8h OR Vancomycin 500 mg IV q6h or 1 g IV q12h
Septic arthritis, streptococcal
1. Streptococcus agalactiae [28]
- Preferred regimen: Penicillin G 2 MU IV/IM q4h OR Ampicillin 2 g IV q6h
- Alternative regimen: Clindamycin 600–1200 mg/day IV/IM q6–12h OR Cefazolin 0.25–1 g IV/IM q6–8h
2. Streptococcus pyogenes
- Preferred regimen: Penicillin G 2 MU IV/IM q4h OR Ampicillin 2 g IV q6h
- Alternative regimen: Clindamycin 600–1200 mg/day IV/IM q6–12h OR Cefazolin 0.25–1 g IV/IM q6–8h
References
- ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
- ↑ 2.0 2.1 Pappas PG, Kauffman CA, Andes D, Benjamin DK, Calandra TF, Edwards JE; et al. (2009). "Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America". Clin Infect Dis. 48 (5): 503–35. doi:10.1086/596757. PMID 19191635.
- ↑ Spellberg B, Lipsky BA (2012). "Systemic antibiotic therapy for chronic osteomyelitis in adults". Clin Infect Dis. 54 (3): 393–407. doi:10.1093/cid/cir842. PMC 3491855. PMID 22157324.
- ↑ http://www.uptodate.com/contents/search?search=chronic+osteomyelitis&sp=0&searchType=PLAIN_TEXT&source=USER_INPUT&searchControl=TOP_PULLDOWN&searchOffset=. Missing or empty
|title=(help) - ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
- ↑ Lipsky BA, Berendt AR, Cornia PB, Pile JC, Peters EJ, Armstrong DG; et al. (2013). "2012 infectious diseases society of america clinical practice guideline for the diagnosis and treatment of diabetic foot infections". J Am Podiatr Med Assoc. 103 (1): 2–7. PMID 23328846.
- ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
- ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
- ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
- ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
- ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
- ↑ Gentry LO (1991). "Oral antimicrobial therapy for osteomyelitis". Ann Intern Med. 114 (11): 986–7. PMID 2024868.
- ↑ Marschall J, Bhavan KP, Olsen MA, Fraser VJ, Wright NM, Warren DK (2011). "The impact of prebiopsy antibiotics on pathogen recovery in hematogenous vertebral osteomyelitis". Clin Infect Dis. 52 (7): 867–72. doi:10.1093/cid/cir062. PMC 3106232. PMID 21427393.
- ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
- ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
- ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
- ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
- ↑ Corbel, Michael (2006). Brucellosis in humans and animals. Geneva: World Health Organization. ISBN 9241547138.
- ↑ Shirtliff ME, Mader JT (2002). "Acute septic arthritis". Clin Microbiol Rev. 15 (4): 527–44. PMC 126863. PMID 12364368.
- ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
- ↑ Wheat LJ, Freifeld AG, Kleiman MB, Baddley JW, McKinsey DS, Loyd JE; et al. (2007). "Clinical practice guidelines for the management of patients with histoplasmosis: 2007 update by the Infectious Diseases Society of America". Clin Infect Dis. 45 (7): 807–25. doi:10.1086/521259. PMID 17806045.
- ↑ Wormser GP, Dattwyler RJ, Shapiro ED, Halperin JJ, Steere AC, Klempner MS; et al. (2006). "The clinical assessment, treatment, and prevention of lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America". Clin Infect Dis. 43 (9): 1089–134. doi:10.1086/508667. PMID 17029130.
- ↑ Treatment of Tuberculosis: Guidelines. WHO Guidelines Approved by the Guidelines Review Committee (4th ed.). Geneva: World Health Organization. 2010. ISBN 9789241547833. PMID 23741786. Retrieved 2015-06-08.
- ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
- ↑ Osmon DR, Berbari EF, Berendt AR, Lew D, Zimmerli W, Steckelberg JM; et al. (2013). "Executive summary: diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America". Clin Infect Dis. 56 (1): 1–10. doi:10.1093/cid/cis966. PMID 23230301.
- ↑ Liu C, Bayer A, Cosgrove SE, Daum RS, Fridkin SK, Gorwitz RJ; et al. (2011). "Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children". Clin Infect Dis. 52 (3): e18–55. doi:10.1093/cid/ciq146. PMID 21208910.
- ↑ Sharff KA, Richards EP, Townes JM (2013). "Clinical management of septic arthritis". Curr Rheumatol Rep. 15 (6): 332. doi:10.1007/s11926-013-0332-4. PMID 23591823.
- ↑ "Clinical Management of Septic Arthritis" (PDF).