Penicillin hypersensitivity regimens for patients with vertebral osteomyelitis who have not had a recent spinal procedure and are at increased risk of infection with gram-negative organisms

Modified regimens are included below for adults with vertebral osteomyelitis who are at increased risk of infection with gram-negative organisms (see Aetiology of osteomyelitis in adults) 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:

For adults who have had a severe immediate¹ hypersensitivity reaction to a penicillin, cefazolin plus ciprofloxacin (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 ciprofloxacin is not used, or for adults who have had a severe delayed² hypersensitivity reaction to a penicillin, as a 2-drug regimen, use: