IDSA GUIDELINES Bundle (free trial)

Prosthetic Joint Infection

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Treatment ����Chronic suppressive therapy is therefore generally reserved for patients who are unsuitable for, or refuse, further exchange revision, excision arthroplasty, or amputation. PJI DUE TO OTHER ORGANISMS ����Treat with 4-6 weeks of pathogen-specific intravenous or highly bioavailable oral antimicrobial therapy (Table 2) (A-II). ����Follow published guidelines for monitoring outpatient IV antimicrobial therapy [Tice AD. op. cit.] (A-II). ����Indefinite chronic oral antimicrobial suppression should follow regimens in Table 3 and be based on in vitro sensitivities, allergies and intolerances (B-III). ������ Chronic suppression after fluoroquinolone treatment of gram-negative bacilli is not unanimously recommended. ������ Clinical and laboratory monitoring for efficacy and toxicity is advisable. ������ Similar considerations regarding hazards and effectiveness apply to the above. PJI following resection arthroplasty with or without planned staged reimplantation ����4-6 weeks of pathogen-specific intravenous or highly bioavailable oral antimicrobial therapy is recommended (Tables 1&2) (A-II). ����Monitoring of outpatient IV antimicrobial therapy should follow published guidelines [Tice AD. op. cit.] (A-II). PJI following one-stage exchange STAPHYLOCOCCAL PJI ����Treat with 2-6 weeks of pathogen-specific intravenous antimicrobial therapy in combination with rifampin 300-450 mg orally bid followed by rifampin plus a companion oral drug for a total of 3 months (Table 2) (C-III). ������ Recommended oral companion drugs for rifampin include ciprofloxacin (A-I) or levofloxacin (A-II). ������ Secondary companion drugs to be used if in vitro susceptibility, allergies, intolerances or potential intolerances support the use of an agent other than a quinolone include but are not limited to co-trimoxazole (A-II), minocycline, doxycycline (B-III) or oral first generation cephalosporins such as cephalexin or antistaphylococcal penicillins such as dicloxacillin (C-III). ������ If rifampin cannot be used due to allergy, toxicity or intolerance, treat with 4-6 weeks of pathogen-specific intravenous antimicrobial therapy. ����Follow published guidelines to monitor outpatient IV antimicrobial therapy [Tice AD. op. cit.] (A-II). 6

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