Treatment
Table 1. Intravenous or Highly Bioavailable Oral
Antimicrobial Treatment of Common Microorganisms
Causing PJI (B-III unless otherwise stated in text)
Microorganism
Preferred Treatmenta
Staphylococci, oxacillin-susceptible
Nafcillinb sodium 1.5-2 g IV q4-6h
OR
Cefazolin 1-2 g IV q8h
OR
Ceftriaxonec 1-2 gms IV q24h
Vancomycind IV 15 mg/kg q12h
Staphylococci, oxacillin-resistant
Enterococcus spp, penicillinsusceptible
Penicillin G 20-24 million units IV q24h
continuously or in 6 divided doses
OR
Ampicillin sodium 12 g IV q24h continuously or
in 6 divided doses
Enterococcus spp, penicillinresistant
Vancomycin 15 mg/kg IV q12h
Pseudomonas aeruginosa
Cefepime 2 g IV q12h
OR
Meropeneme 1 g IV q8h
Enterobacter spp
Cefepime 2 g IV q12h
OR
Ertapenem 1 g IV q24h
IV ��-lactam based on in-vitro susceptibilities
OR
Ciprofloxacin 750 mg PO bid
Penicillin G 20-24 million units IV q24h
continuously or in 6 divided doses
OR
Ceftriaxone 2 g IV q24h
Penicillin G 20 million units IV q24h
continuously or in 6 divided doses
OR
Ceftriaxone 2 g IV q24h
Enterobacteriaceae
��-hemolytic streptococci
Propionibacterium acnes
Antimicrobial dosage needs to be adjusted based on patients��� renal and hepatic function. Antimicrobials
should be chosen based on in vitro susceptibility as well as patient drug allergies, intolerances and potential
drug interactions or contraindications to a specific antimicrobial. Clinical and laboratory monitoring for
efficacy and safety should occur based on prior IDSA guidelines. The possibility of prolonged QTc interval
and tendonapathy should be discussed and monitored when using fluoroquinolones. The possibility of
C. difficile colitis should also be discussed when using any antimicrobial.
b
Flucloxacillin may be used in Europe. Oxacillin can also be subsitiuted.
c
There was no consensus on the use of ceftriaxone for methicillin susceptible staphylococci (See full text
guidelines)
a
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