Biomedical Science Letters

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Table. 3.

Antimicrobial treatment

Microorganisms Antibiotics (dose) Microorganisms Antibiotics (dose)
Staphylococcus sp. Gram-negative bacteria
Oxacillin-/methicillin-susceptible Cefazolin(3×2 g, i.v.)* + Rifampin, (2×450 mg, p.o.), Duration 2 week Enterobacteriaceae (Escherichia coli, Klebsiella, Enterobacter, etc.) Ciprofloxacin (2×750 mg, p.o.)
Oxacillin-/methicillin-resistant Vancomycin (2×1 g, i.v.) + Rifampin (2×450 mg. p.o.), Duration 2 week Nonfermenters (Pseudomonas aeruginosa, Acinetobacter sp.) Piperacillin/tazobactam (3×4.5 g, i.v.) or Meropenem (3×1 g, i.v.) or Ceftazidim (3×2 g, i.v.) + Gentamicin (1×240 mg, i.v.), Duration 2~3 week
Rifampicin-resistant§ Vancomycin (2×1 g, i.v.), Duration 2 week Ciprofloxacin-resistant§ Depending on susceptibility: meropenem (3×1 g), colistin (3×3 million U) and/or fosfomycin (3×5 g), i.v.
Streptococcus sp. Penicillin G (4×5 million U, i.v.)* or Ceftriaxon (1×2 g, i.v.), Duration 2 week Anaerobes
Enterococcus sp. Gram-positive anaerobes (Propionibacterium, Peptostreptococcus, Finegoldia magna) Penicillin G (4×5 million U, i.v.)* or Ceftriaxon (1×2 g, i.v.) + Rifampin (2×450 mg, p.o.), Duration 2 week
Penicillin-susceptible Ampicillin (4×2 g, i.v.)* + Gentamicin (2×60~80 mg, i.v.), Duration 2~3 week Gram-negative anaerobes (Bacteroides sp.) Clindamycin (3×600 mg, i.v.), Duration 2 week
Penicillin-resistant§ Vancomycin (2×1 g, i.v.) or + Gentamicin (2×60~80 mg, i.v.), Duration 2~4 week Candida sp.
Fluconazole-susceptible§ Caspofungin (1×50 mg, 1st day: 70 mg; i.v.), Duration 2 week

Total treatment duration: usually 2 weeks intravenously followed by oral administration

Dose-adjustment according to renal function and body weight (< 40 kg or > 100 kg)

i.v.: intravenously; p.o.: per oral

Rifampin is administered only after the new prosthesis is implanted, wounds are dried and drains are removed; in patients aged >75 years, the rifampicin dose reduced to 2×300 mg, p.o.

*In case of anaphylaxis (such as Quinckés edema, bronchospasm, anaphylactic shock) or cephalosporin allergy: vancomycin (21 g, i.v.)

Check vancomycin trough concentration (take blood before next dose) at least 1 time per week; therapeutic range, 15~20 µg/mL

Give only, if gentamicin high-level (HL) is tested susceptible. In gentamicin HL-resistant enterococci: gentamicin is exchanged with ceftriaxone (1×2 g, i.v.)

Biomed Sci Letters 2022;28:1-8 https://doi.org/10.15616/BSL.2022.28.1.1
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