Empiric antibiotic therapy for psoas abscess in adults*

Empiric therapy with activity against methicillin-resistant Staphylococcus aureus
Preferred	Vancomycin^¶
Alternatives	Daptomycin (6 mg/kg IV once daily)
	Linezolid (600 mg IV or orally twice daily)
PLUS
Empiric therapy with activity against gram-negative and anaerobic pathogens
Monotherapy with a beta-lactam-beta-lactamase inhibitor, such as one of the following:
Ampicillin-sulbactam (3 g every 6 hours)
Piperacillin/tazobactam (3.375 g every 6 hours)
Ticarcillin-clavulanate (3.1 g every 4 to 6 hours)
A third-generation cephalosporin such as ceftriaxone (1 g IV every 24 hours) PLUS metronidazole (500 mg IV every 8 hours)
A fluoroquinolone (eg, ciprofloxacin 400 mg IV every 12 hours or levofloxacin 500 mg IV daily) PLUS metronidazole (500 mg IV every 8 hours)
Monotherapy with a carbapenem^Δ such as one of the following:
Imipenem (500 mg every 6 hours)
Meropenem (1 g every 8 hours)
Ertapenem (1 g daily)

IV: intravenously; AUC: area under the 24-hour time-concentration curve.
* Antibiotic therapy should be tailored to culture and sensitivity data when available.
¶ For severely ill patients, a vancomycin loading dose (20 to 35 mg/kg) is appropriate; within this range, we use a higher dose for critically ill patients. The loading dose is based on actual body weight, rounded to the nearest 250 mg increment and not exceeding 3000 mg. The initial maintenance dose and interval are determined by nomogram (typically 15 to 20 mg/kg every 8 to 12 hours for most patients with normal renal function). Subsequent dose and interval adjustments are based on AUC-guided or trough-guided serum concentration monitoring. Refer to the UpToDate topic on vancomycin dosing for sample nomogram and discussion of vancomycin monitoring.
Δ Carbapenems should not be used for patients with history of immediate-type hypersensitivity to beta-lactams.

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Empiric antibiotic therapy for psoas abscess in adults*