Table 120-2 Selection of Antibiotics for Treatment of Acute Osteomyelitis Suggested Regimena Organism Primary Alternativesb Staphylococcus aureus Penicillin- Nafcillin or oxacillin, 2 g Cefazolin, 1 g IV resistant, methicillin- IV q4h q8h; ceftriaxone, 1 g IV q24h; clindamycin, 900 mg IV q8hc sensitive (MSSA) Penicillinsensitive Penicillin, 3–4 million U IV q4h Cefazolin, ceftriaxone, clindamycin (as above) Methicillinresistant (MRSA) Vancomycin, 15 mg/kg Clindamycinc (as IV q12h; rifampin, 300 mg PO above); linezolid, 600 q12h (see text) mg IV or PO q12hd; daptomycin, 4–6 mg/kg IV q24hd Streptococci (including S. milleri, bhemolytic streptococci) Penicillin (as above) Cefazolin, ceftriaxone, clindamycin (as above) Gram-negative aerobic bacilli Escherichia Ampicillin, 2 g IV q4h; Ceftriaxone, 1 g IV q24h; parenteral or oral fluoroquinolone . | Chapter 120. Osteomyelitis Part 5 Table 120-2 Selection of Antibiotics for Treatment of Acute Osteomyelitis Suggested Regimen Organism Primary Alternatives Staphylococcus aureus Penicillin- Nafcillin or oxacillin 2 g Cefazolin 1 g IV resistant methicillin- sensitive MSSA IV q4h q8h ceftriaxone 1 g IV q24h clindamycin 900 mg IV q8hc Penicillin- sensitive Penicillin 3-4 million U IV q4h Cefazolin ceftriaxone clindamycin as above Methicillin- resistant MRSA Vancomycin 15 mg kg IV q12h rifampin 300 mg PO q12h see text Clindamycinc as above linezolid 600 mg IV or PO q12li daptomycin 4-6 mg kg IV q24hrf Streptococci including S. milleri b-hemolytic streptococci Penicillin as above Cefazolin ceftriaxone clindamycin as above Gram-negative aerobic bacilli Escherichia coli other sensitive species Ampicillin 2 g IV q4h cefazolin 1 g IV q8h Ceftriaxone 1 g IV q24h parenteral or oral fluoroquinolone . ciprofloxacin 400 mg IV or 750 mg PO q12h e Pseudomonas aeruginosa Extended-spectrum b-lactam agent . piperacillin 3-4 g IV q4-6h or ceftazidime 2 g IV q12h plus tobramycin 5-7 mg kg q24h May substitute parenteral or oral fluoroquinolone for b-lactam agents if patient is allergic or for tobramycin in relation to nephrotoxicity Enterobacter Extended-spectrum b-
