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

Modified regimens are included below for adults with vertebral osteomyelitis who are at increased risk of infection caused by MRSA and 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 patients 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, ceftriaxone 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 ceftriaxone 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: