{ "schema_version": 1, "kind": "condition", "id": "osteomyelitis-referral", "name": "Osteomyelitis (Referral)", "category": "infectious", "sources": "2015 IDSA Clinical Practice Guidelines for the Diagnosis and Treatment of Native Vertebral Osteomyelitis in Adults · Egyptian National Drug Formulary - Antimicrobial 2023", "review_status": "reviewed", "verified_against": "2015 IDSA Clinical Practice Guidelines for the Diagnosis and Treatment of Native Vertebral Osteomyelitis in Adults · Egyptian National Drug Formulary - Antimicrobial 2023", "verified_date": "2026-08", "treatments": [ { "id": 1269, "generic": "Emergency hospital admission and parenteral antibiotic therapy (Surgical & ID Referral)", "line": 1, "is_adjunct": false, "form": null, "strength_mg": null, "adult_dose": "Arrange immediate emergency hospital admission to orthopaedics or infectious diseases. Get blood cultures and imaging FIRST. In a haemodynamically stable patient with a normal neurological examination, hold antibiotics until there is a microbiological diagnosis - IDSA recommendation 24. Treat blind only if the patient is unstable: sepsis, or a progressing neurological deficit. Surgical debridement or drainage as indicated", "adult_duration": "Immediate emergency referral; 6 weeks of parenteral or highly bioavailable oral therapy for most patients, 3 months for Brucella", "dose_source": "2015 IDSA Clinical Practice Guidelines for the Diagnosis and Treatment of Native Vertebral Osteomyelitis in Adults", "rationale": "Acute osteomyelitis is a surgical and medical emergency requiring urgent hospital admission, bone biopsy/cultures, parenteral high-dose antibiotics, and potential surgical debridement.", "cautions": [ "Do not start antibiotics before cultures in a stable patient. A blind start sterilises the cultures and leaves months of treatment aimed at a guess. The exception is the unstable patient, where the delay costs more than the culture.", "TIME-CRITICAL EMERGENCY: Primary care physicians must refer immediately for inpatient management; delay risks chronic osteomyelitis, permanent limb disability, pathological fracture, and sepsis.", "Do not attempt outpatient oral antibiotic monotherapy without hospital evaluation and microbiological diagnosis.", "In diabetic foot osteomyelitis or open fractures, empiric regimen must cover polymicrobial Gram-negative and anaerobic pathogens.", "The guideline this is drawn from covers native vertebral osteomyelitis in adults. Long-bone disease, prosthetic joints and children are outside its scope.", "What the hospital will start once cultures are taken, for the call ahead: ceftriaxone 2 g IV daily plus vancomycin 15-20 mg/kg IV every 12 hours, or cefazolin or flucloxacillin where the organism allows." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Immediate emergency admission to pediatric orthopedics for parenteral antibiotic therapy and surgical drainage of subperiosteal abscess if present.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [], "condition_id": "osteomyelitis-referral" }, { "id": 1271, "generic": "Clindamycin", "line": 2, "is_adjunct": false, "form": "injection", "strength_mg": 600.0, "adult_dose": "600-900 mg IV every 8 hours, or 300-450 mg orally four times daily as targeted step-down after hospital stabilisation", "adult_duration": "6 weeks total", "dose_source": "Egyptian National Drug Formulary - Antimicrobial 2023", "rationale": "High bone tissue penetration; preferred alternative for staphylococcal osteomyelitis in penicillin-allergic patients.", "cautions": [ "High risk of Clostridioides difficile-associated diarrhea; warn patient to report watery diarrhea immediately.", "Monitor hepatic and renal function during prolonged therapy." ], "peds_mgkg_low": 20.0, "peds_mgkg_high": 40.0, "peds_max_mg": 1800.0, "peds_basis": "day", "peds_unit": "mg", "peds_note": "Child: 20-40 mg/kg/day IV/oral divided in 3-4 doses, maximum 1800 mg daily. 2700 mg is the adult ceiling and does not apply to a child. Hospital administration mandatory.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": [ { "weight_kg": 10, "low_mg": 200, "high_mg": 400, "capped": false }, { "weight_kg": 20, "low_mg": 400, "high_mg": 800, "capped": false }, { "weight_kg": 30, "low_mg": 600, "high_mg": 1200, "capped": false }, { "weight_kg": 40, "low_mg": 800, "high_mg": 1600, "capped": false } ], "brands": [ { "trade_name": "DALACIN C 600MG I.M./I.V. 4 ML AMP.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PFIZER", "price_egp": 148.0, "pack_count": null, "unit_price": null, "strength_mg": 600.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ALFACLINDAMYCIN 600MG/4ML 5 AMP. I.V./I.M. INJ.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ALEXANDRIA > ROTABIOGEN", "price_egp": 295.0, "pack_count": null, "unit_price": null, "strength_mg": 600.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "osteomyelitis-referral" }, { "id": 1270, "generic": "Ceftriaxone", "line": 1, "is_adjunct": true, "form": "injection", "strength_mg": 2000.0, "adult_dose": "2 g IV once daily as part of the inpatient parenteral regimen", "adult_duration": "6 weeks total (inpatient or outpatient parenteral therapy)", "dose_source": "2015 IDSA Clinical Practice Guidelines for the Diagnosis and Treatment of Native Vertebral Osteomyelitis in Adults", "rationale": "First-line broad-spectrum parenteral cephalosporin for Gram-negative and streptococcal osteomyelitis, combined with anti-staphylococcal therapy.", "cautions": [ "Contraindicated in severe anaphylactic allergy to cephalosporins or penicillins.", "Do not co-administer with IV calcium-containing solutions due to risk of precipitation.", "2 g every 12 hours is the meningitis and CNS dose, not the bone one. The formulary reserves it for that." ], "peds_mgkg_low": 50.0, "peds_mgkg_high": 100.0, "peds_max_mg": 2000.0, "peds_basis": "day", "peds_unit": "mg", "peds_note": "Child: 50-100 mg/kg/day IV in 1-2 divided doses (max 2000 mg daily). Hospital administration mandatory.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": [ { "weight_kg": 10, "low_mg": 500, "high_mg": 1000, "capped": false }, { "weight_kg": 20, "low_mg": 1000, "high_mg": 2000, "capped": false }, { "weight_kg": 30, "low_mg": 1500, "high_mg": 2000, "capped": true }, { "weight_kg": 40, "low_mg": 2000, "high_mg": 2000, "capped": true } ], "brands": [ { "trade_name": "ZOXIDEL 2 GM PD. FOR I.V. INJ.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "RAMEDA > DELTA PHARMA", "price_egp": 33.0, "pack_count": null, "unit_price": null, "strength_mg": 2000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "EPICEPHIN 2 GM I.V. VIAL", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EIPICO", "price_egp": 77.0, "pack_count": null, "unit_price": null, "strength_mg": 2000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "XORAXON 2 GM I.V. VIAL", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MUP", "price_egp": 83.0, "pack_count": null, "unit_price": null, "strength_mg": 2000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CEFAXONE 2 GM I.V. VIAL", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHARCO B", "price_egp": 96.0, "pack_count": null, "unit_price": null, "strength_mg": 2000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "osteomyelitis-referral" }, { "id": 1272, "generic": "Vancomycin", "line": 1, "is_adjunct": true, "form": "injection", "strength_mg": 500.0, "adult_dose": "Intermittent infusion: 15 to 20 mg/kg/dose (rounded to the nearest 250 mg) every 8 to 12 hours initially; for serious MRSA infections, adjust based on therapeutic monitoring.", "adult_duration": "6 weeks total", "dose_source": "Egyptian National Drug Formulary - Antimicrobial 2023", "rationale": "Glycopeptide antibiotic providing anti-MRSA parenteral coverage in suspected or documented staphylococcal osteomyelitis.", "cautions": [ "Hypersensitivity to vancomycin or any component of the formulation", "Vancomycin infusion reaction; slow infusion rate to avoid histamine release.", "Monitor vancomycin serum concentrations and renal function." ], "peds_mgkg_low": 60.0, "peds_mgkg_high": 80.0, "peds_max_mg": 3600.0, "peds_basis": "day", "peds_unit": "mg", "peds_note": "Infants ≥3 months and Children <12 years: IV: Initial: 60 to 80 mg/kg/day in divided doses every 6 hours; initial maximum daily dose: 3,600 mg/day.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": [ { "weight_kg": 10, "low_mg": 600, "high_mg": 800, "capped": false }, { "weight_kg": 20, "low_mg": 1200, "high_mg": 1600, "capped": false }, { "weight_kg": 30, "low_mg": 1800, "high_mg": 2400, "capped": false }, { "weight_kg": 40, "low_mg": 2400, "high_mg": 3200, "capped": false } ], "brands": [ { "trade_name": "KEMPOVANCOM 500 MG VIAL", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "KAHIRA > MODERN OFFICE FOR IMPORT", "price_egp": 18.0, "pack_count": null, "unit_price": null, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "VANCOZIN 500 MG VIAL", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EIMC > KOREA UNITED PHARMA", "price_egp": 38.0, "pack_count": null, "unit_price": null, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "VANCOMIX 500MG I.V. VIAL", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SIGMA TEC", "price_egp": 79.0, "pack_count": null, "unit_price": null, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "VANCOGUT 500 MG PD. FOR I.V. INF. VIAL", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ARABCOMED", "price_egp": 95.0, "pack_count": null, "unit_price": null, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "VANCOLON 500MG I.V. VIAL", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "JULPHAR", "price_egp": 95.5, "pack_count": null, "unit_price": null, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "EDICIN 500 MG PD FOR I.V. INF. VIAL", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "GLOBAL PHARMACEUTICAL INDUSTRIES", "price_egp": 118.0, "pack_count": null, "unit_price": null, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "VANCOBACT 500 MG VIAL FOR I.V. INF.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ARABCOMED > EGYPHARMA", "price_egp": 118.0, "pack_count": null, "unit_price": null, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "VANCOMYCINE VIATRIS 500 MG VIAL", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "VIANAX - GREECE > ONE PHARMA MEDICS", "price_egp": 142.0, "pack_count": null, "unit_price": null, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "osteomyelitis-referral" } ] }