Bone and Joint

Question 1

Discitis/Vertebral Osteomyelitis

Answer 1

Vancomycin 25-30 mg/kg then 15-20mg/Kg BID
Plus
Cefepime 2g IV TID or Cipro 400mg IV TID

Question 2

Infectious Tenosynovitis

Answer 2

Vancomycin 25-30 mg/kg then 15-20mg/Kg BID
Plus
Ceftriaxone 1g IV daily or Levofloxacin 750mg IV daily

Question 3

Adult Bite Wound (what pathogen for each bite type)

Answer 3

Common org: Staph, strep, fusobacterium, bacteroides,
Cat: Pasturella Multocida
Dog: Capnocytophaga Canimorsus
Human: Eikenella Corrodens

Question 4

Adult Bite Wound Tenosynovitis (Treatment)

Answer 4

Vancomycin 25-30 mg/kg then 15-20mg/Kg BID
Plus
Amp/sulbactam (unasyn) 3g IV QID or
Ceftriaxone 1g IV and Metro 500 IV TID or
Levo 750 IV daily and Metro 500 IV TID

Question 5

Water related Tenosynovitis

Answer 5

Mycobacterium is suspected: Add on
Clarithromycin 500mg PO BID 
Plus
Ethambutol 15mg/kg PO Daily
Rifampin 600mg PO Daily

Pseudomonas suspected: Add on
Levofloxacin 750 PO daily

Question 6

Disseminated gonococcal w/ chlamydia suspected

Answer 6

Ceftriaxone 1g IV Daily
Plus
Azithromycin 1g PO once or
Doxy 100mg PO BID

Question 7

Open Fracture; define type 1, type 2, and type 3

Answer 7

Type 1: wound < 1cm, Clean, simple fracture
Type 2: wound > 1cm, no flaps or avulsions, simple fracture, limited soft tissue damage
Type 3: High energy injury or extensive soft tissue damage, segmental fracture or bone loss, crush injury, Vascular injury, severe contamination, injury involving farm equipment

Question 8

Open Fracture Type 1 or Type 2 Abx

Answer 8

Cefazolin 2g (30mg/kg) IV TID

Question 9

Open Fracture Type 1 or Type 2 Abx if severely penicillin allergic

Answer 9

Vancomycin 25-30 mg/kg then 15-20mg/Kg BID

Question 10

Open Fracture type 3

Answer 10

Ancef 2g IV TID or Vanc 25-30mg/kg
Plus
Gentamicin 5-7mg/kg IV once daily

If vascular injury or soil contamination (concern for clostridia)
Zosyn 4.5g IV TID as monotherapy

Question 11

Adult osteomyelitis

Answer 11

Vancomycin 25-30 mg/kg then 15-20mg/Kg BID
Plus
Ceftriaxone 2g IV once daily or
If Pseudomonas suspected (puncture, diabetes, sickle cell, IV drug) Cefepime 2g IV TID or Cipro 400mg IV TID

Question 12

Pediatric Sickle Cell Osteomyelitis

Answer 12

Ceftriaxone 100mg/kg IV once daily and Vanc 15mg/kg IV QID

Question 13

Non Gonococcal Septic Arthritis

Answer 13

Vancomycin 25-30 mg/kg then 15-20mg/Kg BID 
Plus
Ceftriaxone 1 g IV once daily or 
Cefepime 1-2g IV TID or
Cipro 400mg IV TID

Question 14

Gonococcal Septic Arthritis

Answer 14

Ceftriaxone 1g IV daily

Question 15

Sickle Cell Septic Arthritis

Answer 15

Vanc 25-30 mg/kg then 15-20mg/Kg BID
plus
Cipro 400mg IV TID or
Imipenem/Cilastin 1g IV TID

Question 16

Septic Bursitis (mild inflammation)

Answer 16

2-3 weeks duration
Bactrim 1-2 DS tablets PO BID or
Clinda 450mg PO TID

Question 17

Septic Bursitis (Severe Inflammation)

Answer 17

Vanc 25-30 mg/kg then 15-20mg/Kg BID or
Linezolid 600mg IV BID or
Clinda 600mg IV TID
(consider in immunocomp, diabetic, or those req drainage)