Antibiotic choice for vertebral osteomyelitis not associated with spinal epidural abscess in adults who have a normal neurological examination

In adults with vertebral osteomyelitis who have a normal neurological examination and do not have spinal epidural abscess, sepsis or septic shock, withhold antibiotic therapy until a definitive microbiological diagnosis is made. Closely monitor for neurological compromise, including the emergence of symptoms or signs of cord compression or radiculopathy.

If signs or symptoms of neurological compromise develop, manage as for Vertebral osteomyelitis associated with spinal epidural abscess or neurological compromise in adults – urgent empirical antibiotic therapy is required.

Once the pathogen is identified, start directed therapy. Regimens are included for:

• methicillin-susceptible Staphylococcus aureus (MSSA) native bone or joint infection
• methicillin-resistant Staphylococcus aureus (MRSA) native bone or joint infection
• Kingella kingae native bone or joint infection
• native bone or joint infection caused by other pathogens.

If a microbiological diagnosis cannot be achieved, treatment choice depends on whether the infection follows a spinal procedure. For infection not associated with a spinal procedure, treatment is chosen based on the patient’s risk of infection with MRSA or a gram-negative organism. Empirical regimens are included for adults who:

• have had a recent spinal procedure
• have not had a recent spinal procedure and are at low risk of infection caused by MRSA or gram-negative organisms
• have not had a recent spinal procedure and are at increased risk of infection caused by MRSA or gram-negative organisms.