這是從harrison整理出來的表格

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TABLE 120-2. Selection of antibiotics for treatment of acute  osteomyelitis

 

Suggested Regimena

 Organism

Primary

Alternativesb

Staphylococcus aureus

 

 

 Penicillin-resistant, methicillin-sensitive (MSSA)

Nafcillin or oxacillin, 2 g IV q4h

Cefazolin, 1 g IV q8h; ceftriaxone, 1 g IV q24h; clindamycin, 900 mg IV q8hc

 Penicillin-sensitive

Penicillin, 3-4 million U IV q4h

Cefazolin, ceftriaxone, clindamycin (as above)

 Methicillin-resistant (MRSA)

Vancomycin, 15 mg/kg IV q12h; rifampin, 300 mg PO q12h (see text)

Clindamycinc (as above); linezolid, 600 mg IV or PO q12hd; daptomycin, 4-6 mg/kg IV q24hd

Streptococci (including S. milleri, β-hemolytic streptococci)

Penicillin (as above)

Cefazolin, ceftriaxone, clindamycin (as above)

Gram-negative aerobic bacilli

 

 

 Escherichia coli, other "sensitive" species

Ampicillin, 2 g IV q4h; cefazolin, 1 g IV q8h

Ceftriaxone, 1 g IV q24h; parenteral or oral fluoroquinolone (e.g., ciprofloxacin, 400 mg IV or 750 mg PO q12h)e

Pseudomonas aeruginosa

Extended-spectrum β-lactam agent (e.g., piperacillin, 3-4 g IV q4-6h; or ceftazidime, 2 g IV q12h) plus tobramycin, 5-7 mg/kg q24hf

May substitute parenteral or oral fluoroquinolone for β-lactam agents (if patient is allergic) or for tobramycin (in relation to nephrotoxicity)

Enterobacter spp., other "resistant" species

Extended-spectrum β-lactam agent IV or fluoroquinolone IV or POe (as above)

 

Mixed infections possibly involving anaerobic bacteria

Ampicillin/sulbactam, 1.5-3 g IV q6h; piperacillin/tazobactam, 3.375 g IV q6h

Carbapenem antibiotic or a combination of a fluoroquinolone plus clindamycin (as above) or metronidazole, 500 mg PO tid

 

aDuration of treatment is discussed in the text.

bCephalosporins may be used for the treatment of patients allergic to penicillin whose reaction did not consist of anaphylaxis or urticaria (immediate-type hypersensitivity).

cBecause of the possibility of inducible resistance, clindamycin must be used with caution for the treatment of strains resistant to erythromycin. Consult clinical microbiology laboratory.

dExperience is limited; there are anecdotal reports of efficacy.

eOral fluoroquinolones must not be coadministered with divalent cations (calcium, magnesium, iron, aluminum), which block the drugs' absorption.

fTobramycin levels and renal function must be monitored closely to minimize the risks of nephro- and ototoxicity.

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