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Prosthetic Joint Infection

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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 10

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