Clinical features

  • Pain
  • Erythema
  • Swelling
  • Sinus tract formation
  • Fever and systemic upset

Investigations

  • Blood culture
  • Bone biopsy

Infection Control

Basic universal precautions

Treatment

Source control may be required to achieve a successful outcome, including bone debridement (which also provides samples for culture) – discuss with Orthopaedics

Chronic infection may not require immediate treatment if the patient is otherwise well. Aim to obtain culture samples prior to treatment

Rifampicin has excellent oral bioavailability. IV is not required unless the oral route is compromised

FLUCLOXACILLIN IV 2g 6 hourly

after 48 hours, or after source control Add

RIFAMPICIN PO 450mg 12 hourly

If true penicillin allergy or known MRSA:

VANCOMYCIN IV Dose as per calculator

Target trough 15-20 mg / L

after 48 hours, or after source control Add

RIFAMPICIN PO 450mg 12 hourlyDuration: Discuss with Microbiology