Microorganism | Antibiotic | Dosagea | Durationc |
---|---|---|---|
S. aureus or flucloxacillin-sensitive coagulase-negative Staphylococci (CoNS) | Flucloxacillin | 2.000 mg loading dose, followed by 12.000 mg/24 h continuous infusion IV | 1–2 wks |
plus | |||
Rifampinb | 450 mg b.i.d. oral | 1–2 weeks | |
followed by: | |||
Moxifloxacin or | 400 mg q.d. oral | 10–11 weeks | |
Levofloxacin | 500 mg b.i.d. oral | ||
plus | |||
Rifampinb | 450 mg b.i.d. oral | 10–11 weeks | |
Methicillin resistent S. aureus or flucloxacillin coagulase-negative Staphylococci (CoNS) | Vancomycin | 20 mg/kg loading dose, followed by 30 mg/kg/24 h continuous infusion (with adjustments based on blood level monitoring) | 1–2 weeks |
plus | |||
Rifampinb | 450 mg b.i.d. oral | 1–2 weeks | |
followed by: | |||
Moxifloxacin or | 400 mg q.d. oral | 10–11 weeks | |
Levofloxacin | 500 mg b.i.d. oral | 10–11 weeks | |
plus | |||
Rifampinb | 450 mg b.i.d. oral | 10–11 weeks | |
In the case of chinolon resistance: | |||
Clindamycin or | 600 mg t.i.d. oral | 10–11 weeks | |
Minocyclin or | 100 mg b.i.d. (first dose 200 mg) oral | 10–11 weeks | |
Co-trimoxazole | 960 mg t.i.d. oral | 10–11 weeks | |
All in combination with Rifampinb | 450 mg b.i.d. oral | 10–11 weeks | |
In the case of linezolid, use only as monotherapy (not combined with rifampin) | 600 mg b.i.d. oral | max. 6 weeks, then switch to alternative | |
Streptococci | Benzylpenicillin | 2 million units loading dose, followed by 12 million units/24 h continuous infusion IV | 2 weeks |
or | |||
Ceftriaxone | 2.000 mg once daily IV or 2.000 mg loading dose, followed by 2.000 mg/24 h continuous infusion IV | 2 weeks | |
± Rifampin [20]b | 450 mg b.i.d. oral | 12 weeks | |
followed by: | |||
Amoxicillin | 750–1000 t.i.d. mg oral | 10 weeks | |
± Rifampin [20]b | 450 mg b.i.d. oral | 10 weeks | |
Enterococci (amoxicillin-sensitive) | Amoxicillin | 2.000 mg loading dose, followed by 12.000 mg/24 h continuous infusion IV | 4 weeks |
plus | |||
Ceftriaxone | 2.000 mg b.i.d. IV or 2.000 mg loading dose, followed by 4.000 mg/24 h continuous infusion | 4 weeks | |
followed by: | |||
Amoxicillin | 750–1000 mg t.i.d. oral | 8 weeks | |
Enterococci (amoxicillin-resistant) | Vancomycin | 20 mg/kg loading dose, followed by 30 mg/kg/24 h continuous infusion (with adjustments based on blood level monitoring) | 6 weeks |
plus | |||
Gentamicin# | 3 mg/kg q.d. IV (with adjustments based on blood level monitoring) | 2 weeks | |
followed by: | |||
Linezolid§ | 600 mg b.i.d. oral (preferably with blood level monitoring) | 6 weeks | |
Enterobacteriaceae (e.g. E. coli, Klebsiella, Proteus) | Ceftriaxone | 2.000 mg once daily IV or 2.000 mg loading dose, followed by 2.000 mg/24 h continuous infusion | 1–2 weeks |
followed by: | |||
Ciprofloxacin | 750 mg b.i.d. oral | 10–11 weeks | |
In case of ciprofloxacin resistance: | |||
Cotrimoxazole | 960 mg t.i.d. oral | 10–11 weeks | |
Nonfermenters (e.g. Pseudomonas aeruginosa) | Ceftazidime | 2.000 mg t.i.d. IV or 2.000 mg loading dose, followed by 6.000 mg/24 h continuous infusion IV | 1–2 weeks |
plus | |||
Ciprofloxacin | 400 mg t.i.d. IV (or directly 750 mg b.i.d. oral) | 1–2 weeks | |
followed by: | |||
Ciprofloxacin | 750 mg b.i.d. oral | 10–11 weeks | |
Cutibacterium acnes (Propionibacterium acnes) | Benzylpenicillin | 2 million units loading dose, followed by 12 million units/24 h continuous infusion IV | 1–2 weeks |
or | |||
Ceftriaxone | 2.000 mg once daily IV or 2.000 mg loading dose, followed by 2.000 mg/24 h continuous infusion | 1–2 weeks | |
followed by: | |||
Amoxicillin | 750–1000 mg t.i.d. oral | 10–11 weeks | |
or | |||
Clindamycin | 600 mg t.i.d. oral | 10–11 weeks | |
Corynebacterium species | Vancomycin | 20 mg/kg loading dose, followed by 30 mg/kg/24 h continuous infusion (with adjustments based on blood level monitoring) | 1–2 weeks |
followed by: | |||
Cotrimoxazole | 960 mg t.i.d. oral | 10–11 weeks | |
or | |||
Clindamycin | 600 mg t.i.d. oral | 10–11 weeks | |
or | |||
Minocyclin | 200 mg loading dose, followed by 100 mg b.i.d oral | 10–11 weeks | |
If resistant for the above: | |||
Vancomycin | 20 mg/kg loading dose, followed by 30 mg/kg/24 h continuous infusion (with adjustments based on blood level monitoring) | 6 weeks | |
or | |||
Dalbavancin | 1500 mg once every two weeks | 6 weeks (3x) | |
followed by: | |||
Linezolidd | 600 mg b.i.d. oral | 6 weeks | |
Candidal species (fluconazol-sensitive) | Caspofungin | 70 mg IV loading dose, followed by 50 mg q.d. if < 80 kg, and 70 mg q.d. if > 80 mg | 2–4 weekse |
followed by: | |||
Fluconazole | 800 mg loading dose, followed b 400 mg q.d. oral | 5 months | |
In the case of 2-stage revision: | |||
500 mg conventional amfotericin B or 200 mg liposomal amfotericin B in cement spacerf |