Patients with vertebral osteomyelitis who have not had a recent spinal procedure and are at low risk of infection caused by MRSA or gram-negative organisms
Therapy targeting methicillin-susceptible S. aureus (MSSA) and beta-haemolytic streptococci is appropriate for patients with vertebral osteomyelitis who are at low risk of infection caused by MRSA (see Risk factors for infection with methicillin-resistant Staphylococcus aureus) or a gram-negative organism (see Aetiology of osteomyelitis in adults).
For adults who have a normal neurological examination; do not have spinal epidural abscess, sepsis or septic shock; and have not had a recent spinal procedure, use:
flucloxacillin 2 g intravenously, 6-hourly. For dosage adjustment in adults with kidney impairment, see flucloxacillin intravenous dosage adjustment. See advice on intravenous to oral switch and duration of therapy. flucloxacillin flucloxacillin flucloxacillin
For adults who have had a nonsevere (immediate or delayed) hypersensitivity reaction to a penicillin, 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
For adults who have had a severe immediate1 hypersensitivity reaction to a penicillin, cefazolin (at the dosage above) can be considered if a beta-lactam antibiotic 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 is not used, or for adults who have had a severe delayed2 hypersensitivity reaction to a penicillin, use:
vancomycin intravenously; for initial dosing, see Intermittent vancomycin dosing for noncritically ill adults. See advice on intravenous to oral switch and duration of therapy. vancomycin vancomycin vancomycin