Penicillin hypersensitivity regimens for patients with vertebral osteomyelitis who have not had a recent spinal procedure and are at increased risk of MRSA infection
Modified regimens are included below for adults with vertebral osteomyelitis who are at increased risk of MRSA and have had a hypersensitivity reaction to a penicillin. These regimens are appropriate for patients who have a normal neurological examination; do not have spinal epidural abscess, sepsis or septic shock; and have not had a recent spinal procedure.
For adults who have had a nonsevere (immediate or delayed) hypersensitivity reaction to a penicillin, as a 2-drug regimen, use:
cefazolin 2 g intravenously, 8-hourly. For dosage adjustment in adults with kidney impairment, see cefazolin dosage adjustment. See advice on intravenous to oral switch and duration of therapy cefazolin cefazolin cefazolin
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vancomycin intravenously; for initial dosing, see Intermittent vancomycin dosing for noncritically ill adults. See advice on intravenous to oral switch and duration of therapyvancomycinvancomycinvancomycin.
For adults who have had a severe immediate1 hypersensitivity reaction to a penicillin, cefazolin 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 cefazolin plus vancomycin is not used, or for adults who have had a severe delayed2 hypersensitivity reaction to a penicillin, use vancomycin monotherapy (see dosage above).