BONE AND JOINT INFECTIONS.doc

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Bahan Untuk Penyusunan Pedomam Antibiotik 2011 RSU TIDAR MAGELAG

1! Da"i Uni#e"sitas Pensi$#ania Ame"ika Se"ikat

B%E AD &%IT I'E(TI%S($ini)a$

Settin* Em+i"i)

T"eatment Like$y Patho*ens De,initi#e

T"eatment Dosa*e

Re*imen Du"ation

%steomye$itis1

Normal

Host

na,)i$$in2 o"

)e,a-o$in2 S. aureus

nafcillin2 or

cefazolin2

2gm IV q 4-6

hour

500mg IV q 8hour

6 weesminimum!

then

continueuntil "#$

normal%!4"ntero&acteriaceae

'occasionall() *+,#+.

8-

10mgg/a(

*+, IV, in%-4 /ii/e/

/oses

Intraenous

rug 3ser

#an)omy)in .

*entami)in

same as a&oe

methicillin resistantS. aureus

same as

emiric 'if

culture /atanot

aaila&le)

gentamicin5 -see this lin

2 wees

ancom(cin -see this lin

6 wees

minimum!

thencontinue

until "#$

normal4

,ost-

oeratieTMP/SM S. aureus

nafcillin2 or

cefazolin2

2gm IV q 4-6hour

500mg IV q 8

hour6 weesminimum!

then

continueuntil "#$

normal%!4

coagulase negatiestah(lococcus

ancom(cin see this lin

"ntero&acteriaceae *+,#+.

8-

10mgg/a(

*+, IV in %-4/ii/e/ /oses

P. aeruginosa

ieracillin

gentamicin

4 gm IV q 6

hour

see this lin

,ost-

traumatic

amicillin

sul&actam6

same as a&oe!

inclu/ing7

same as

a&oe

same as a&oe 6 wees

minimum!

http://www.uphs.upenn.edu/bugdrug/antibiotic_manual/amino.htmhttp://www.uphs.upenn.edu/bugdrug/antibiotic_manual/vanco.htmhttp://www.uphs.upenn.edu/bugdrug/antibiotic_manual/vanco.htmhttp://www.uphs.upenn.edu/bugdrug/antibiotic_manual/amino.htmhttp://www.uphs.upenn.edu/bugdrug/antibiotic_manual/vanco.htmhttp://www.uphs.upenn.edu/bugdrug/antibiotic_manual/vanco.htmhttp://www.uphs.upenn.edu/bugdrug/antibiotic_manual/amino.htmhttp://www.uphs.upenn.edu/bugdrug/antibiotic_manual/amino.htm


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then

continue

until "#$normal%!4

anaero&es 'eseciall(

lostri/ia s9) enicillin :

2mu IV q 4

hour

ontiguouswith

/ecu&itusulcer

/ia&etic foot

TMP/SM met"onida-o$e34

ol(micro&ial same asemiric

*+,#+. 8-10mgg/a(

*+, IV in %-4/ii/e/ /oses

metroni/azole

500mg IV,q 12 hour

6 weesminimum!

thencontinue

until "#$

normal%!4

1'o" o+tima$ t"eatment3 mi)"oo"*anism5s6 shou$d be identi,ied by as+i"ation o" bone bio+sy7

deb"idement 8i$$ enhan)e )u"e "ate

2I, beta9$a)tam a$$e"*y use )$indamy)in o" t"imetho+"im su$,ametho:a-o$e7 i, MRSA9use #an)omy)in

;Shou$d s8it)h to o"a$ the"a+y on)e )$ini)a$ im+"o#ement o))u"s

(an s8it)h to $e#o,$o:a)in >00m* P% ? 2< hou" in )ombination 8ith I@ #an)omy)in

=Am+i)i$$in/su$ba)tam dose1!>*m I@ ? = hou"s

Met"onida-o$e use i, ,ou$ odo" +"esent

4ot ,o" a**"essi#e anae"obi) in,e)tions in diabeti) hosts

B%E AD &%IT I'E(TI%S9(ontCd!

($ini)a$

Settin* Em+i"i)

T"eatment Like$y Patho*ens De,initi#e

T"eatment Dosa*e

Re*imen Du"ation

Se+ti) A"th"itis1

Normal

Host

na,)i$$in2 o"

)e,a-o$in

2

S. aureus nafcillin2 or

cefazolin

2

2gm IV q 4-6

hour

500mg IV q8 hour

4-6

wees%

"ntero&acteriaceae *+,#+. 8-

10mgg/a(

*+, IV in %-4 /ii/e/

/oses


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grou ; stretococcus enicillin :

8-12mu/ IV

in 4-6

/ii/e/ /oses

#e(e,i:ime is a non9,o"mu$a"y a*ent a non,o"mu$a"y "e?uest ,o"m must be )om+$eted

=Remo#a$ o, +"osthesis may be "e?ui"ed

May "e?ui"e subse?uent o"a$ the"a+y to e"adi)ate in,e)tion

http://www.uphs.upenn.edu/bugdrug/antibiotic_manual/vanco.htmhttp://www.uphs.upenn.edu/bugdrug/antibiotic_manual/amino.htmhttp://www.uphs.upenn.edu/bugdrug/antibiotic_manual/vanco.htmhttp://www.uphs.upenn.edu/bugdrug/antibiotic_manual/amino.htm


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(ETRAL ER@%US SSTEM I'E(TI%S

Re)ommendations a"e ,o" em+i"i) the"a+y!

Di"e)ted the"a+y shou$d be based u+on )u$tu"e and sensiti#ity "esu$ts!

($ini)a$

Settin*Like$y Patho*ens

Em+i"i) T"eatment

%+tionsDu"ation/(omments

+eningitis

ommunit(-

acquire/

meningitis!age 18-50

S. pneumoniae

N. meningitidis

H. influenzae

ceftria


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10mg once /ail( eer( 1-%

/a(s until clinical an/

micro&iologic imroement

occurs9 *he gentamicin must &e reseratie free9

';miacin can &e use/ in

lace of gentamicin at thesame /osage9)

>rain ;&scess

ommunit(-

acquire/ &rain

a&scess

uer resirator( flora ceftria


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ain!*+,#+.

failure)

H. influenzae

*+,#+.

160800mg'1 /ou&le

strengthta&let) ,>I

M.catarrhalis

oral anaero&es

Tonsi$$itis/ Pha"yn*itis

+il/ +eni)i$$in @4grou ;stretococcus

enicillin V

250mg ,

q 6 hour-10 /a(s

+o/erate5ben-athine +eni)i$$in

G to 2>

0 m* +o ?id7 i, a$$e"*y se#e"e 5u"ti)a"ia3 an*ioedema3 o" ana+hy$a:is6 then ey"th"omy)in 2>0 m* +o ?id 5)he)k sus)e+tibi$ity 9

"esistan)e "ate >9106

> I, mu$ti+$e o" "e)u""ent e+isodes3 )onside" )$indamy)in 1>0 m* +o ?id 5)he)k sus)e+t 9 >910

"esistan)e63 amo:i)i$$in/)$a#u$ani) a)id >00 m* +o bid o" ben-athine +eni)i$$in 1!2 mu IM on)e!

Ri,am+in )an be added to e"adi)ate st"e+to)o))i ,"om the +ha"yn: 5=00 m* +o ?d : < d6

=Abs)ess shou$d be d"ained


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UI@ERSIT %' PESL@AIA MEDI(AL (ETER GUIDELIES '%R

ATIBI%TI( USE

GASTR%ITESTIAL I'E(TI%S

Re)ommendations a"e ,o" em+i"i) the"a+y!

Di"e)ted the"a+y shou$d be based u+on )u$tu"e and sensiti#ity "esu$ts!

($ini)a$ Settin* Like$y Patho*ens

Em+i"i) T"eatment %+tions

5no"ma$ "ena$ ,un)tion 9 see

dosin* in "ena$ im+ai"ment

+a*e ,o" adHustments ,o"

"ena$ insu,,i)ien)y6

Du"ation/(omments

Un)om+$i)ated int"a9abdomina$ in,e)tions 'e9g9 communit(-

acquire/ infections such

as /ierticulitis! eritonitis! an/

cholec(stitischolangitis

without a&scess)

"ntero&acteriaceae

"nterococcus s9

anaero&es

tion 1

cefazolin 500mg IV q8h

metroni/azole 500mg IV or ,q12h

tion 2

amicillinsul&actam 195g IV

q6h

B-lactam allerg( otion 1

trimethorimsulfametho


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with a&scess or recent

&iliar( instrumentation!

secon/ar( eritonitis!immunocomromise/

atients)

"nterococcus s9

anaero&es

tion 2

cefeime 1g IV q12h

metroni/azole 500mg IV q12h

B-lactam allerg(

leoflo


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If not tolerating oral

me/ications

metroni/azole 500mg IV q8h

N* &e as effectie as

oral thera(9

#eere C. difficile

• F> G 25!000uA

• H(otension

• I3 atients

• #eere a&/ominal ain

• #econ/ recurrence

• No imroement after 5 /a(s of

metroni/azole

ancom(cin 125mg , q6h Du"ation 10 days

or mare/l( seerecases! consi/er

com&ination thera(!

surger( consult! an/ Iconsult9

Vancom(cin IV is

ineffectie for the

treatment of C. difficile9

Ba)te"ia$

*ast"oente"itis and/o"

t"a#e$e"Cs dia""hea

Salmonella s9

Shigella s9

Campylobacter

s9

E. coli

;nti&iotics shoul/ not &e rescri&e/ routinel( as

anti&acterial treatment ma(

worsen outcomes9

*reatment shoul/ &e consi/ere/

in7

19 $eturning traelers with

mo/erate to seere/iarrhea

29 Immunocomromise/

atients

%9 eer an/ signs ofinasie /isease

tion 1

azithrom(cin 500mg , q24h

tion 2 'for traelers

/iarrhea)

rifaacteremic salmonella

infections requirelonger treatment

/uration9 I consult

shoul/ &e consi/ere/9


10/17

Cryptosporidium

parvum

nitazo days

S+ontaneous ba)te"ia$ +e"itonitis 5SBP6

#>, without recent

anti&iotic e


11/17

295 mg/A9

H. pylori 9asso)iated

disease

H. pylori clarithrom(cin 500mg , q12h

amo


12/17

;cute

,rostatitis ;> yea"s o$d

ceftria


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function)

3ncomlicate/

3*I 'a/mitte/ M

48 hrs)

cefazolin

o"

cehale


14/17

a&normalities!flan ain!

eleate/ s(stemic

F>)

o"

cefeime2

q24h

Enterococcus s9%

amicillin

gentamicin

1 gram IV

q6h

see /osinggui/elines

,seu/omonasaeruginosa

ieracillin

.

gentamicin

o"

cefeime

% grams

IV q6h


1 gram IV

q12h

an/i/a al&icans fluconazole 100 mg, q24h

,elic

Inflammator(isease

clin/am(cin

gentamicin

N. gonorrhoeae" C.

trachomatis!"ntero&acteriaceae!

#acteroides s9!Streptococcus s9

clin/am(cin

gentamicin

00 mg IV

q8h


14 /a(

total4

"n/om(ometritis clin/am(cin

gentamicin

amicillin

+i


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1 If seere enicillin allerg( 'urticaria! angioe/ema! anah(la


16/17

S. aureus

nafcillin5 or

cefazolin5

2gm IV q 4-6 hr

500mg IV q 8 hr

$. baumanii reiew susceti&ilit( /ata

T"a)heob"on)hitis

;cute TMP/SM S. pneumoniae amo


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BONE AND JOINT INFECTIONS.doc

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