Bone and joint antibiotics

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Diabetic foot infection

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

Superficial Mild Infections

Prior antibiotic treatment or moderate infections

Inpatient Treatment


Diskitis or Osteomyelitis

Inpatient Therapy

Felon

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

Infectious Tenosynovitis

Treatment should cover S. aureus, Streptococcus, and MRSA

Animal Bites

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

Pediatrics

Open fracture

  • NNT 12.5 to prevent early fracture site infection[1]

Grade I Fracture Options

Grade II/III Fracture Options

  • Add Gentamicin 300 mg (1-1.7mg/kg) IV to any of the Grade I regemins
    • Once daily dosing has been shown to be safe and effective
  • If concern for Clostridium then consider single drug regimen of Pipericillin/Tazobactam 4.5g (80mg/kg) IV TID

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

Non-Gonococcal

Pediatrics

Septic Bursitis

Cover Staphylococcus aureus (80-90%) and Streptococcus

Outpatient Options

Inpatient Options

Antibiotics by diagnosis

For antibiotics by organism see Microbiology (Main)

References

  1. Gosselin RA, et al. Antibiotics for preventing infection in open limb fractures. Cochrane Database Syst Rev. 2004; (1):CD003764.