tailieunhanh - Chapter 120. Osteomyelitis (Part 6)

Specific therapy is ultimately based on in vitro susceptibility testing of the organism(s) isolated from bone or blood. Outpatient parenteral antimicrobial therapy (OPAT) is appropriate for motivated and medically stable patients and represents a significant advance in management. Antibiotics that require infrequent dosing, such as ceftriaxone, ertapenem, daptomycin, and vancomycin, may facilitate home therapy, but these choices often have an overly broad spectrum of activity. Fortunately, many antibiotics can be given automatically by means of a portable infusion pump, which decreases the disruption otherwise caused by frequent administration of a drug. Use of a peripherally inserted central catheter (PICC. | Chapter 120. Osteomyelitis Part 6 Specific therapy is ultimately based on in vitro susceptibility testing of the organism s isolated from bone or blood. Outpatient parenteral antimicrobial therapy OPAT is appropriate for motivated and medically stable patients and represents a significant advance in management. Antibiotics that require infrequent dosing such as ceftriaxone ertapenem daptomycin and vancomycin may facilitate home therapy but these choices often have an overly broad spectrum of activity. Fortunately many antibiotics can be given automatically by means of a portable infusion pump which decreases the disruption otherwise caused by frequent administration of a drug. Use of a peripherally inserted central catheter PICC line also greatly facilitates outpatient drug administration. OPAT requires close coordination of nursing pharmacy and physician care with clear delineations of responsibility for monitoring of safety and efficacy. After administration of parenteral therapy for 5-10 days and after resolution of signs of active infection oral antibiotics have been used with great success in children with hematogenous osteomyelitis. The doses of oral penicillins or cephalosporins required for the treatment of pediatric osteomyelitis are high and adults may not tolerate such doses as well as children. With the exception of the fluoroquinolones rifampin and linezolid few data support the use of oral antibiotics for adults with osteomyelitis. For treatment of infection due to Enterobacteriaceae oral administration of a fluoroquinolone has been as successful as IV administration of 0-lactam antibiotics. Caution should be exercised in the use of fluoroquinolones as the sole agents for treatment of infection due to S. aureus or P. aeruginosa because resistance may develop during therapy. Addition of oral rifampin 300 mg bid to a fluoroquinolone has yielded encouraging results in infections due to S. aureus but potential drug toxicity and drug interactions make this