Pathogen-specific Antibiotics for B&J Infections:
| Organism | Drugs of Choice | Alternative Drugs | Remarks |
| MSSA | -Cloxacillin -Flucloxacillin -Cefazolin |
-Ceftriaxone -Daptomycin |
Rifampicin 300-450mg PO/day may be added in presence of hardware Possible antagonism with Beta-lactams. Best results if along with FQN (FQN use is unlikely in India due to widespread resistance) |
| MRSA | -Vancomycin -Teicoplanin |
-Daptomycin - Linezolid |
-Rifampicin 300-450mg PO/day (as above) -High dose of vancomycin used 15-20mg/kg q8-12h (max. 2g/dose) Monitor trough levels, renal function |
| Β-hemolytic Streptococcus | -Penicillin G - Ampicillin -Ceftriaxone |
Vancomycin (if immediate hypersensitivity to Pen) | Monitor vancomycin trough levels |
| Enterococcus spp. Penicillin-susceptible Penicillin resistant |
-Penicillin G - Ampicillin Vancomycin -Teicoplanin |
-Vancomycin -Teicoplanin -Daptomycin - Linezolid |
-Combination therapy with aminoglycoside not proven superior in PJI -May use BLBLI (piperacillin-tazobactam) for BLase producers - VRE to be treated as per individual susceptibility (daptomycin, linezolid) are options |
| Pseudomonas spp. | Ceftazidime Cefepime |
-Piperacillin tazobactam -Meropenem (for ESBL producers) -Polymyxin / Colistin |
Ciprofloxacin 750mg PO BD may be used upfront if susceptible (good penetration & bioavailability) -Renal dose adjustment for colistin only (Polymyxins have poor B&J penetration, use antibiotic laden spacer/ beads) |
| Enterobacteriaceae | Beta-lactam based on in vitro susceptibility | Piperacillin-tazobactam Meropenem (for ESBL producers) -Polymyxin / Colistin |
Ciprofloxacin 750mg PO BD may be used upfront if susceptible (good penetration & bioavailability)
-Renal dose adjustment for colistin only (Polymyxins have poor B&J penetration, use antibiotic laden spacer/ beads) |
| Propionibacterium acnes | Ceftriaxone | -Vancomycin -Clindamycin |
Monitor vancomycin trough levels Higher risk of CDAD with clindamycin prolonged use |
| Gram- neg. Anaerobes | Metronidazole | Metronidazole need not be added for additional anaerobic cover in presence of BLBLI/ carbapenems |
*Parenteral antibiotics are generally recommended for at least the 1st 2 weeks, may step down to oral antibiotics with good bioavailability if susceptible to complete the course of treatment
** Antibiotic-impregnated cement spacers/beads must be considered in addition to systemic antibiotics especially in resistant infections with few drug options/ drugs which have poor B&J penetration/ drug toxicity.