Children
- Surgical debridement and drainage of associated soft tissue or boney abscesses recommended.
- If unresponsive to cefazolin IV after 3-5 days, consider:
- bone biopsy for pathology and cultures
- Infectious Diseases consult.
- Consider change to oral therapy if all of the following are true:
- acute hematogenous osteomyelitis
- clinically well
- falling CRP
- compliance of patient and parents guaranteed.
S. aureus/MRSA
Others:
Group A Streptococci
S. pneumoniae
H. influenzae
Kingella spp (< 4 y.o.)
Anaerobes
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Cefazolin | 100mg/kg/d IV div q8h | 3-4 weeks |
Stepdown if cultures negative or pathogen susceptible
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Cloxacillin | 100mg/kg/d PO div q6h | to complete 3-4 weeks |
| or | ||
| Cephalexin | 100mg/kg/d PO div q6h | to complete 3-4 weeks |
| or | ||
| Clindamycin | 30-40mg/kg/d PO div qid | to complete 3-4 weeks |
If MRSA colonized
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Vancomycin | 60mg/kg/d IV div q6h | 3-4 weeks |