Patients with vertebral osteomyelitis associated with spinal epidural abscess or neurological compromise who have had a recent spinal procedure

Urgent empirical antibiotic therapy is required for patients with vertebral osteomyelitis associated with spinal epidural abscess or neurological compromise. For adults who have had a recent spinal procedure, as a 2-drug regimen, use initially:

cefepime 2 g intravenously, 8-hourly. For dosage adjustment in adults with kidney impairment, see cefepime dosage adjustment. See advice on intravenous to oral switch and duration of therapy cefepime cefepime cefepime

PLUS

vancomycin intravenously; for initial dosing, see Vancomycin dosing in adults. Loading doses are recommended for critically ill adults. See advice on intravenous to oral switch and duration of therapy. vancomycin vancomycin vancomycin

For adults who have had a nonsevere (immediate or delayed) hypersensitivity reaction to a penicillin, use cefepime plus vancomycin (see dosages above).

For adults who have had a severe immediate1 hypersensitivity reaction to a penicillin, cefepime plus vancomycin (see dosages above) can be considered if a beta-lactam–based regimen is strongly preferred (for considerations, see Severe immediate hypersensitivity: Implications of cross-reactivity between penicillins and cephalosporins).

For adults who have had a severe immediate1 hypersensitivity reaction to a penicillin in whom cefepime plus vancomycin is not used, or for adults who have had a severe delayed2 hypersensitivity reaction to a penicillin, as a 2-drug regimen, use initially:

vancomycin intravenously; for initial dosing, see Vancomycin dosing in adults. Loading doses are recommended for critically ill adults. See advice on intravenous to oral switch and duration of therapyvancomycinvancomycinvancomycin

PLUS EITHER

1ciprofloxacin 400 mg intravenously, 8-hourly. For dosage adjustment in adults with kidney impairment, see ciprofloxacin intravenous dosage adjustment. See advice on intravenous to oral switch and duration of therapy ciprofloxacin ciprofloxacin ciprofloxacin

OR

1ciprofloxacin 750 mg orally, 12-hourly. For dosage adjustment in adults with kidney impairment, see ciprofloxacin oral dosage adjustment. See advice on duration of therapyciprofloxacinciprofloxacinciprofloxacin.

1 Severe immediate hypersensitivity reactions include anaphylaxis, compromised airway, airway angioedema, hypotension and collapse.Return
2 Severe delayed hypersensitivity reactions include cutaneous adverse drug reactions (eg drug rash with eosinophilia and systemic symptoms [DRESS], Stevens–Johnson syndrome/toxic epidermal necrolysis [SJS/TEN], severe blistering or desquamative rash), and significant internal organ involvement (eg acute interstitial nephritis).Return