Bone & Joint Tx Guidelines

Question 1

Osteomyelitis PO

Answer 1

• Streptococci: Amox, Cephalexin, Clindamycin (+/- Rifampin)
• MSSA: Dicloxacillin, Cephalexin, Cefadroxil, Bactrim, Linezolid (+/- Rifampin)
• MRSA: Linezolid, Bactrim, Clinda (+/- Rifampin)
• G(-): Bactrim, FQ’s

Question 2

PJI: Amputation w/ complete removal

Answer 2

Targeted Tx x 24-48 hours

Question 3

PJI: 1 Stage Exchange

Answer 3

• Targeted Tx + Rifampin x 2-6 weeks
• Oral Antibiotics + Rifampin x 3 months

Question 4

Prosthetic Joint Infxn (options)

Answer 4

• MSSA Coverage: Cefazolin *, Ceftriaxone *, Cefepime *, Zosyn, Unasyn, Meropenem, Ciproflox *, Levoflox * ( * =add Metronid if anaerobic coverage needed)
• PLUS MRSA Coverage: Vanc, Dapto, Linezolid

Question 5

Septic Arthritis

Answer 5

• MSSA Coverage: Cefazolin *, Ceftriaxone *, Cefepime *, Zosyn, Unasyn, Meropenem, Ciproflox *, Levoflox * ( * =add Metronid if anaerobic coverage needed)
• PLUS MRSA Coverage: Vanc, Dapto, Linezolid
• 2-4 weeks

Question 6

PJI: Debridement and Retention of Prosthesis

Answer 6

• Targeted Tx + Rifampin x 2-6 weeks
• Oral Antibiotics + Rifampin x 3 months (HIP) - 6 months (KNEE, or other joint)

Question 7

PJI: 2 Stage Exchange

Answer 7

Targeted Tx x 4-6 weeks

Question 8

Osteomyelitis IV

Answer 8

• MSSA Coverage: Cefazolin *, Ceftriaxone *, Cefepime *, Zosyn, Unasyn, Meropenem, Ciproflox *, Levoflox * ( * =add Metronid if anaerobic coverage needed)
• PLUS MRSA Coverage: Vanc, Dapto, Linezolid
• Consider Dalbavancin
• 4-8 weeks