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Bone and Joint

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Acute Osteomyelitis and Septic Arthritis

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Acute Osteomyelitis and Septic Arthritis

Pathogens

Drug Treatment

Empiric

Non-vertebral osteomyelitis and septic arthritis

flucloxacillin

HMLSchedNZFPMLnoids

IV 2 g every six hours

If risk factors for MRSA, add:

vancomycin

HMLSchedNZFPMLnoids

See dosing guidelines.

Mild penicillin allergy

cefazolin

HMLSchedNZFPMLnoids

IV 2 g every eight hours

If risk factors for MRSA, add:

vancomycin

HMLSchedNZFPMLnoids

See dosing guidelines.

Severe penicillin allergy

vancomycin

HMLSchedNZFPMLnoids

See dosing guidelines.

Vertebral osteomyelitis

Consult Infectious Diseases/Clinical Microbiology.

Pathogens Known

S. aureus

Methicillin susceptible S. aureus (MSSA)

See empiric treatment.

Methicillin resistant S. aureus (MRSA)

vancomycin

HMLSchedNZFPMLnoids

See dosing guidelines.

Streptococcus (Note: check susceptibility)

benzylpenicillin

HMLSchedNZFPMLnoids

(Penicillin G)

IV 1.8 g (3 megaunits) every four hours

Mild penicillin allergy (Note: check susceptibility)

cefazolin

HMLSchedNZFPMLnoids

IV 2 g every eight hours

Severe penicillin allergy (Note: check susceptibility)

vancomycin

HMLSchedNZFPMLnoids

See dosing guidelines.

Enterobacteriaceae (mainly coliforms)

Treat according to known or local susceptibilities.

Pseudomonas aeruginosa (suspect if penetrating foot injury through a shoe)

Consult Infectious Diseases/Clinical Microbiology.

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Topic Code: 99210