Empiric antimicrobial therapy for infants <3 months of age with acute hematogenous osteomyelitis and/or bacterial arthritis

This algorithm is intended for use with UpToDate content on management of osteomyelitis and/or bacterial arthritis in children. Refer to UpToDate content for additional aspects of management, including indications for surgical intervention and pathogen-directed therapy when results of culture and susceptibility testing are available. For infants with allergy or intolerance to cephalosporins (very uncommon in this age group), we suggest consultation with an expert in pediatric infectious diseases.

MRSA: methicillin-resistant S. aureus; CoNS: coagulase-negative staphylococci; ICU: intensive care unit; MSSA: methicillin-susceptible S. aureus.

* Ceftriaxone is contraindicated in infants ≤28 days if they require or are expected to require concomitant treatment with intravenous solutions containing calcium, including parenteral nutrition.

¶ Some experts would add nafcillin or oxacillin for additional activity against MSSA.

Δ We consider MRSA to be common if ≥10% of S. aureus isolates are MRSA. Other experts may use a different threshold.

◊ At some institutions, clindamycin is used as an alternative to vancomycin if <10% of S. aureus isolates are clindamycin resistant and the infant has localized infection with no signs of sepsis.

§ Some experts also include cefazolin as an antistaphylococcal agent for infants age 1 to 3 months in whom central nervous system infection has been excluded.

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خرید پکیج

Empiric antimicrobial therapy for infants <3 months of age with acute hematogenous osteomyelitis and/or bacterial arthritis