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Suppression of osteomyelitis or prosthetic joint infection in adults: Oral antibiotic regimens*

Suppression of osteomyelitis or prosthetic joint infection in adults: Oral antibiotic regimens*
Infectious agent Antibiotic regimen Dosing
Staphylococci, methicillin susceptible One of the following:
Cefadroxil 500 to 1000 mg twice daily
Cephalexin 500 mg 3 or 4 times daily, or 1000 mg 2 or 3 times daily
Dicloxacillin 500 mg 3 or 4 times daily
Flucloxacillin 500 mg 3 or 4 times daily
Staphylococci, methicillin resistantΔ One of the following:
Trimethoprim-sulfamethoxazole 1 double-strength tablet twice daily
Doxycycline 100 mg twice daily
Minocycline 100 mg twice daily
Clindamycin 600 mg 3 times daily
Gram-negative organisms One of the following:
Trimethoprim-sulfamethoxazole 1 double-strength tablet twice daily
Ciprofloxacin◊ 500 mg twice daily
Levofloxacin◊ 500 mg once daily
Penicillin-sensitive streptococci and enterococci One of the following:
Amoxicillin 500 mg 2 to 3 times daily
Penicillin V K 500 mg 2 to 4 times daily
Cutibacterium (formerly Propionibacterium) acnes One of the following:
Amoxicillin 500 mg 2 to 3 times daily
Penicillin V K 500 mg 2 to 3 times daily
The doses recommended above are intended for adults with normal renal function; the doses of some of these agents must be adjusted in patients with renal insufficiency. Refer to the drug-specific monographs included within UpToDate for renal dose adjustments.

PJI: prosthetic joint infection.

* Initial treatment of PJI consists of definitive antibiotic therapy (refer to the separate UpToDate table); suppressive therapy is warranted only for individuals with retained hardware and/or necrotic bone not amenable to complete debridement. The optimal duration of oral suppressive antibiotic therapy is uncertain. Refer to the UpToDate topic on the treatment of PJI for further discussion.

¶ The choice of antibiotic regimen should be based on susceptibility, as well as patient drug allergies, intolerances, and potential drug-drug interactions or contraindications to a specific agent.

Δ The agents listed for methicillin-resistant staphylococci may be used for suppression of methicillin-susceptible staphylococci in patients with beta-lactam allergy or intolerance, provided the organism is susceptible.

◊ Ciprofloxacin and levofloxacin have activity against Pseudomonas aeruginosa.
Data from:
  1. Osmon DR, Berbari EF, Berendt AR, et al. Diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis. 2013; 56:e1.
  2. Berbari EF, Kanj SS, Kowalski TJ, et al. 2015 Infectious Diseases Society of America (IDSA) clinical practice guidelines for the diagnosis and treatment of native vertebral osteomyelitis in adults. Clin Infect Dis 2015; 61:e26.
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