Empiric antimicrobial therapy for children ≥3 months of age with acute hematogenous osteomyelitis

MRSA: methicillin-resistant S. aureus; Hib: Haemophilus influenzae type b; GI: gastrointestinal; MSSA: methicillin-susceptible S. aureus.
* Alternatives to vancomycin or clindamycin when MRSA is a concern include linezolid or daptomycin (daptomycin only if the child is ≥1 year of age and has no concomitant pulmonary involvement).
¶ For children with life-threatening infections, the combination of vancomycin plus either nafcillin or oxacillin provides bactericidal activity against both MRSA and MSSA.
Δ Consultation with an infectious disease specialist may be warranted for immunocompromised patients (eg, sickle cell disease, chronic granulomatous disease) because they may have infections with unusual pathogens or resistance profiles.
◊ We consider the prevalence of MRSA in the community to be increased if ≥10% of S. aureus isolates are MRSA; other experts may use a different threshold.
§ We consider the prevalence of clindamycin-resistant MRSA to be increased if ≥10% of MRSA isolates are resistant to clindamycin (constitutive and inducible); other experts may use a different threshold.