Hematogenous, Long Bones
- Surgical debridement and drainage of associated soft tissue abscesses recommended.
- Recommend minimum 2 weeks IV antibiotics. Switch to oral agents with good bioavailability and bone penetration [Clin Pharmacokinetics 2009:48;89-124] may be considered with clinical improvement. Oral ß-lactams should not be used as low bioavailability. Ceftriaxone 2g IV daily may be an option for outpatient management [Clin Infect Dis 2012:54; 585-90] but has not been studied in a prospective, randomized controlled trial.
Usual Pathogens
Rare:
Streptococcus spp
Enterobacterales
M. tuberculosis (consult ID)
Dimorphic fungi (consult ID)
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Cloxacillin | 2g IV q4h | 4-6 weeks |
| or | ||
| Cefazolin | 2g IV q8h | 4-6 weeks |
Cefazolin allergy
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Vancomycin | 15mg/kg IV q12h | 4-6 weeks |
If MRSA suspected
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Vancomycin | 15mg/kg IV q12h | minimum 8 weeks |