Alternative Treatmenta
Comments
Vancomycin IV 15 mg/kg q12h
OR
Daptomycin 6 mg/kg IV q24h
OR
Linezolid 600 mg PO/IV q12h
Daptomycin 6 mg/kg IV q24h
OR
Linezolid 600 mg PO/IV q12h
See recommended use of rifampin as a companion
drug for rifampin-susceptible PJI treated with
debridement and retention or one stage exchange
in full text guidelines.
Vancomycin 15 mg/kg IV q12h
OR
Daptomycin 6 mg/kg IV q24h
OR
Linezolid 600 mg PO or
IV q12h
Linezolid 600 mg PO or
IV q12h
OR
Daptomycin 6 mg IV q24h
Ciprofloxacin 750 mg PO bid
or 400 mg IV q12h
OR
Ceftazidime 2g IV q8h
Ciprofloxacin 750 mg PO
or 400 mg IV q12h
See recommended use of rifampin as a companion
drug for rifampin susceptible PJI treated with
debridement and retention or one stage exchange
in full text guidelines.
4-6 weeks aminoglycoside optional.
Vancomycin should be used only for penicillin
allergy.
4-6 weeks.
Addition of aminoglycoside optional.
4-6 weeks.
Addition of aminoglycoside optional.
Use of two active drugs could be considered based
on patient's clinical circumstances.
(If an aminoglycoside is in the spacer and the
organism is aminoglycoside susceptible, double
coverage is being provided with recommended IV
or oral monotherapy)
4-6 weeks.
4-6 weeks.
Vancomycin 15 mg/kg IV q12h
4-6 weeks.
Vancomycin only in case of allergy.
Clindamycin 600-900 mg IV q8h or
Clindamycin 300-450 mg PO qid
OR
Vancomycin 15 mg/kg IV q12h
4-6 weeks.
Vancomycin only in case of allergy.
Target troughs for vancomycin should be chosen with the guidance of a local infectious disease physician
based on the pathogen, its in vitro susceptibility, and the use of rifampin or local vancomycin therapy.
Recent guidelines (Rybak, Liu) for the treatment of MRSA infections have been published. These
guidelines suggest that dosing of vancomycin be considered to achieve a vancomycin trough at steady state
of 15 to 20 mcg/mL. Although this may be appropriate for MRSA PJI treated without rifampin or without
the use of local vancomycin spacer, it is unknown if these higher trough concentrations are necessary when
rifampin or vancomcyin impregnated spacers are utilized. Trough concentrations of at least 10 mcg/mL
may be appropriate in this situation. It is also unknown if treatment of oxcacillin-resistant coagulase
negative staphylococci require vancomycin dosing to achieve these higher vancomycin levels.
e
Other antipseudomonal carbapenems can be utilized as well.
11
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