Published on Infectious Diseases Management Program at UCSF (https://idmp.ucsf.

edu)
Home > Hospitalized Adults: Bone & Joint Infections: Osteomyelitis

Hospitalized Adults: Bone & Joint Infections: Osteomyelitis

Doses provided in this table are for patients with normal renal and hepatic function. Click on drug link to go to dosing guidelines.
Some antimicrobials are restricted (ID-R). Click on link for guidelines on obtaining authorization.

Common Drug(s) of First Alternative

Diagnosis Comments
Pathogens Choice Drug(s)

Osteomyelitis
Presumed
hematogenous source
or contiguous without
vascular insufficiency
If S. aureus is methicillin-
susceptible then cefazolin [1] 2 g
IV q8h or nafcillin [1] 2 g IV q4h
Vancomycin [1] are the antibiotics of choice.
S. aureus Vancomycin [1]
Obtain bone biopsy to determine
microbiologic cause prior to
initiation of antimicrobial therapy
if blood cultures are negative
and patient clinically stable.
 For severe PCN
allergy:

Vancomycin [1]

PLUS ONE OF:

Ciprofloxacin [2]ID-R:
Vancomycin [1] Other organisms are possible,
Osteomyelitis VASF [4] 400 mg IV
esp. with hardware microbiologic
q12h
PLUS ONE OF: diagnosis and ID consultation
With vascular recommended
insufficiency or diabetes OR
S. aureus Piperacillin/
mellitus (e.g. severe Tazobactam [2]ID-R: Obtain bone biopsy to determine
diabetic foot ulcer) Levofloxacin [2]ID-R:
Enterobacteriaceae SFGH [3] 4.5 g IV q6- microbiologic cause prior to
VASF [4] 750 mg IV
8h initiation of antimicrobial therapy
daily
Anaerobes if patient clinically stable
OR OR
Once stable, switch to oral
Ertapenem [2] 1 g Aztreonam [2]ID-R: antibiotics based on
IV daily susceptibility results.
SFGH [3] 2 g IV q8h

ALL WITH OR
WITHOUT:

Metronidazole [2]
500 mg IV q8h (if
patient critically ill)
References:

Lipsky BA, et al. 2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of
diabetic foot infections. Clin Infect Dis 2012; 54:132-173

Contact Us
UCSF Main Site

© 2013 The Regents of the University of California

Source URL: https://idmp.ucsf.edu/hospitalized-adults-bone-joint-infections-osteomyelitis?mag_q=printpdf/251

Links
[1] http://idmp.ucsf.edu/vancomycin-dosing-and-monitoring-recommendations
[2] http://idmp.ucsf.edu/adult-antimicrobial-dosing-non-dialysis
[3] http://idmp.ucsf.edu/restricted-antimicrobials-san-francisco-general-hospital
[4] http://idmp.ucsf.edu/restricted-antimicrobials-veterans-affairs-medical-center-san-francisco