OSTEOMYELITIS / SEPTIC ARTHRITIS Clinical conditions Pathogen(s) (s) Comments Osteomyelitis in Diabetic patients Staph. aureus Follow local guidance Seek specialist advice streptococci

Acute osteomyelitis Staph. aureus Flucloxacillin IV 2g qds Seek specialist advice 2 weeks minimum IV followed by oral therapy Consider referral for outpatient parenteral Total course 4 weeks therapy (OHPAT)

If penicillin allergy Vancomycin IV Chronic osteomyelitis Staph. aureus Oral or Co-trimoxazole If coliforms suspected Occasionally coliforms – seek specialist advice Inc Vertebral Osteomyelitis Debridement usually indicated MRSA osteomyelitis MRS A Vancomycin IV Seek specialist advice Dos ing as per local guidance Aim for trough level of 15-20mg/L Acute septic arthritis Staph. aureus IV flucloxacillin 2g qds for 2 weeks Washout indicated then oral therapy (s ee AMAU/Rheum guidance Total course 4 weeks Consider Neisseria spp and in young adults document) cons ider Chlamydia spp also If penicillin allergy Vancomycin IV Bursitis (septic) Staph. Aureus Oral Flucloxacillin 1g qds May require repeat drainage Occasionally streptococci Total course 1-4 weeks

ORAL NB: All ORAL agents are chosen due to bone/tissue penetration. Adjust doses for renal and liver function

DOXYCYCLINE – 100mg BD MRSA and MSSA cover CO-TRIMOXAZOLE – 960mg BD MRSA cover as per sensitivities

FUSIDIC ACID (SODIUM FUSIDATE) – 500mg TDS – 450mg TDS to QDS MSSA and MRSA cover only if Never prescribe as monotherapy and always check for interactions sensitive Statins s hould be stopped for duration of thera py as per MHRA wa rning MRSA cover as per sensitivities

LINEZOLID – Only on advice of Infection Specialist PRISTINAMYCIN (unlicens ed) – Only on advice of Infection Ref: DO NOT co-prescribe with . Refer to prescribing and Specialist. Refer to prescribing guida nce. BSR Guidelines for Management of Hot Swollen Joints 2006 monitoring guidance

CIPROFLOXACIN – 500-750mg bd gra m nega ti ve cove r Approved AMG: Sep 2019 (750mg bd if Pseudomonas confirmed or if elevated BMI) Review: Sep 2022