Antibiotics
Î In patients with normal and stable neurologic exam and stable
hemodynamics, IDSA suggests holding empiric antimicrobial therapy until
a microbiologic diagnosis is established (W/L).
Î In patients with hemodynamic instability, sepsis, septic shock, severe or
progressive neurologic symptoms, IDSA suggests the initiation of empiric
antimicrobial therapy in conjunction with an attempt at establishing a
microbiologic diagnosis (W/L).
Î IDSA recommends a total duration of 6 weeks of parenteral or highly
bioavailable oral antimicrobial therapy for most patients with bacterial
NVO (S/L).
Î IDSA recommends a total duration of 3 months of antimicrobial therapy for
most patients with NVO due to Brucella sp. (S/M).
Surgery
Î IDSA recommends surgical intervention in patients with progressive
neurologic deficits, progressive deformity and spinal instability with or
without pain despite adequate antimicrobial therapy (S/L).
Î IDSA suggests surgical debridement with or without stabilization in
patients with persistent or recurrent bloodstream infection (without
alternative source) or worsening pain despite appropriate medical therapy
(W/L).
Î IDSA advises against surgical debridement and/or stabilization in
patients who have worsening bony imaging findings at 4-6 weeks in the
setting of improvement in clinical symptoms, physical examination, and
inflammatory markers (W/L).
Follow-Up
Systemic Inflammatory Markers and MRI
Î IDSA suggests monitoring systemic inflammatory markers (ESR and or
CRP) in patients with NVO after approximately 4 weeks of antimicrobial
therapy, in conjunction with a clinical assessment (W/L).
Î IDSA recommends against routinely ordering follow-up MRI in patients
with NVO in whom a favorable clinical and laboratory response to
antimicrobial therapy was observed (S/L).
Î IDSA suggests performing a follow-up MRI to assess evolutionary changes
of the epidural and paraspinal soft tissues in patients with NVO who are
judged to have a poor clinical response to therapy (W/L).
Treatment
