SSTI and Bone and Joint Treatments

Non-purulent, Mild infection Treatment Options

• Penicillin Vk

• Cephalexin

• Dicloxacillin

• Clindamycin (not often used due to side effects)

Non-purulent, Moderate infection Treatment Option

• Penicillin G

• Ceftriaxone

• Cefazolin

• Clindamycin

Non-purulent, Severe Infection Treatment Option

• Vancomycin + piperacillin/tazobactam

Purulent, Empiric, Mild Infection Treatment Option

• Bactrim

• Doxycycline

Purulent, Empiric, Moderate Infection Treatment Option

• Vancomycin

• Daptomycin

• Linezolid

Purulent, Empiric, Severe Infection Treatment Option

• Cefepime OR piper/tazo +

• Vancomycin, OR Daptomycin, OR Linezolid

Purulent, Defined MRSA, Mild Treatment Option

• Bactrim

• Doxycycline

Purulent, Defined MRSA, Moderate Infection Treatment Options

• Vancomycin

• Daptomycin

• Linezolid

Purulent, Defined MRSA, Severe Infection Treatment Options

• Vancomycin

Purulent, Defined MSSA, Mild Treatment Option

• Cephalexin

• Dicloxacillin

Purulent, Defined MSSA, Moderate Infection Treatment Options

• Nafacillin

• Cefazolin

Purulent, Defined MSSA, Severe Infection Treatment Options

• Nafacilln

• Cefazolin

Necrotizing Fasciitis Empiric Treatment

• Broad Spectrum Gram Negative (including pseudomonas)

  • Piper/tazo OR cefepime

• Broad Spectrum Gram Positive (including MRSA)

  • Vancomycin OR Linezolin

• Anaerobes

  • Piper/tazo OR Metronidazole

• Anti-toxin

  • Clindamycin OR Linezolid

Infected animal bite treatment

Amoxicillin/clavulanate 875/125 PO BID

Osteomyelitis, Definitive MSSA, First Line Treatment

• Nafcillin

• Oxacillin

• Cefazolin

Osteomyelitis, Defined MSSA, Alternative Treatment

• Vancomycin

Osteomyelitis, Defined MRSA, First Line Treatment

• Vancomycin

Osteomyelitis, Defined MRSA, Alternative Treatment

• Daptomycin

• Linezolid

Osteomyelitis, Defined Streptococci, First Line Treatment

• Penicillin G

• Ampicillin

• May add an aminoglycoside

Osteomyelitis, Defined Streptococci, Alternative Treatment

• Vancomycin

Osteomyelitis, Defined Gram Negative, First Line Treatment

• Ceftriaxone

• Ceftazidime

• Cefepime

Osteomyelitis, Defined Gram Negative, Alternative Treatment

• Ciprofloxxacin

• Levofloxacin

Osteomyelitis Duration of treatment

4-6 weeks

Septic Joint Infection, Gram positive Cocci, Most Likely Pathogen

• MRSA

• MSSA

• Streptococcus

Septic Joint Infection, Gram Positive cocci, Treatment

• Vancomycin

Septic Joint Infection, Gram Negative bacilli , Most likely pathogens

• E.coli

Septic Joint Infection, Gram Negative Bacilli Treatment

Ceftriaxone

Septic Joint Infection, Nothing on gram strain, Immunocompromised + Risk Factor, Most Likely Pathogen

• MRSA

• MSSA

• Streptococcus

Septic Joint Infection, Nothing on gram strain, Immunocompromised + Risk Factor, Treatment

Vancomycin

Septic Joint Infection, Nothing on Gram Stain, Traumatic Bacterial Arthritis, Most Likely Pathogen

• MRSA

• MSSA

• Streptococcus

• E.coli

Septic Joint Infection, Nothing on Gram Stain, Traumatic Bacterial Arthritis Treatment

Ceftriaxone + Vancomycin

Septic Joint Infection, Nothing on Gram Stain, Immunocompromised + IVDU, Most Likely Pathogen

• MRSA

• Pseudomonas

Septic Joint Infection, Nothing on gram stain, Immunocompromised + IVDU Treatment

• Cefepime OR Piper/Tazo +

• Vancomycin

Prosthetic Joint Infection, MSSA Treatment and Alternative for Penicillin Allergy

• Nafacillin

• Oxacillin

• Cefazolin

Alterantive

• Vancomycin

Prosthetic Joint Infection, MRSA, Treatment and Alternative for Penicillin Allergy

• Vancomycin

• Daptomycin

Alternative

• Vancomycin

• Daptomycin

Prosthetic Joint Infection, Group A Streptococci, Treatment and Alternative for Penicillin Allergy

• Ampicillin

• Cefriaxone

Alternative

• Vancomycin

• Clindamycin

Prosthetic Joint Infection, Enterococcus, Treatment and Alternative for Penicillin Allergy

• Ampicillin

• Vancomycin

Alternative

• Vancomycin

• Daptomycin

Prosthetic Joint Infection, Cutibacterium acnes, Treatment and Alternative for Penicillin Allergy

• Penicillin G

• Ceftriaxone

Alternative

• Vancomycin

• Clindamycin

Prosthetic Joint Infection, Gram-Negative Bacili, Treatment and Alternative for Penicillin Allergy

• Cefepime

• Ceftazidime

Alternative

• Ciprofloxacin

• Meropenem

Prosthetic Joint Infection Surgical Strategy

• Early-onset: Debridement + retention 

• Delayed/Late-onset: Resection arthroplasty ± reimplantation 

• Oral suppressive therapy may follow IV antibiotics