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Acute native osteomyelitis or septic arthritis
 
Please read the following guidance for patients with Myasthenia gravis 
 
First Line
Second Line
​​​Allergy status
(Confirm allergy status prior to choosing antimicrobial regime)
No penicillin allergy
​​
Antimicrobial
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Check for interactions
Flucloxacillin
+/-
Gentamicin STAT
(If systemic upset due to sepsis)
Teicoplanin
+/-
Gentamicin STAT
(If systemic upset due to sepsis)
Dose
Flucloxacillin 2g every 6 hours
+/-
Gentamicin 5mg/kg STAT
(Dose and frequency according to calculator – maximum 450mg in 24 hours)
Teicoplanin loading dose = 12mg/kg every 12 hours for 2 days
(see guidelines for maintenance dose)​
+/-
Gentamicin 5mg/kg STAT
(Dose and frequency according to calculator – maximum 450mg in 24 hours)
Route
IV
IV
Duration
Review with culture and sensitivity results.
Gentamicin should usually be discontinued after intial STAT dose if signs of improvement and no alternative focus of infection identified
 

 

 

Additional Information:
  • Withhold antibiotics pending appropriate microbiological sampling (e.g. synovial fluid aspirate [except in severe sepsis], blood cultures [all cases]).
  • In cases of possible septic arthritis, refer to local guidance for management of the “hot joint”

Duration of antibiotic therapy:

  • Orthopaedic infections are usually treated for 6 weeks from the time of definitive surgery.
  • It may be reasonable to convert antibiotics from intravenous to oral administration within that time however, depending upon patient factors, the bacterial pathogen and the availability of agents with good oral bioavailability for treating it. 
  • Treatment durations of greater than 6 weeks may be considered in certain circumstances, but should be agreed on a case-by-case basis through the MDT