Antibiotics - Bone & Joint



Cellulitis

Infection

Osteomyelitis and septic arthritis

Most likely organisms

S aureus, group A Streptococci and other Streptococci.

Empiric treatment

Flucloxacillin 2g q6h iv
plus
Benzylpenicillin
2.4g q6h iv.

Consider addition of Fusidic acid (sodium fusidate) 500mg q8h po for confirmed S. aureus infection.

In penicillin allergy

Vancomycin 25mg/kg (max 2g) loading dose then 15mg/kg q12h iv.

Consider addition of Fusidic acid (sodium fusidate) 500mg q8h po for confirmed S. aureus infection.

Vancomycin pre-dose level: aim for 15-20mg/L.

Duration

Septic arthritis: 4-6 weeks, IV for 14 days.

Osteomyelitis: 6 weeks (although may require up to 3 months), iv therapy for 14-21 days. Shorter duration of iv if responding - e.g. iv therapy for minimum 7 days.

Comments

Always seek advice from microbiology or infections diseases.

Vancomycin dosing.



Content By Dr. Íomhar O' Sullivan 10/08/2010. Last review Dr. ÍOS 10/06/17.