Treatment
ÎÎChronic 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
ÎÎTreat with 4-6 weeks of pathogen-specific intravenous or highly
bioavailable oral antimicrobial therapy (Table 2) (A-II).
ÎÎFollow published guidelines for monitoring outpatient IV antimicrobial
therapy [Tice AD. op. cit.] (A-II).
ÎÎIndefinite 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
ÎÎ4-6 weeks of pathogen-specific intravenous or highly bioavailable oral
antimicrobial therapy is recommended (Tables 1&2) (A-II).
ÎÎMonitoring of outpatient IV antimicrobial therapy should follow
published guidelines [Tice AD. op. cit.] (A-II).
PJI following one-stage exchange
STAPHYLOCOCCAL PJI
ÎÎTreat 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.
ÎÎFollow published guidelines to monitor outpatient IV antimicrobial
therapy [Tice AD. op. cit.] (A-II).
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