# Osteomyelitis (Referral) - Category: infectious - Review status: reviewed (every claim checked against a document named on this page) - Sources: 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 ## Verified against - 2015 IDSA Clinical Practice Guidelines for the Diagnosis and Treatment of Native Vertebral Osteomyelitis in Adults - Egyptian National Drug Formulary - Antimicrobial 2023 ## Treatment metadata - Emergency hospital admission and parenteral antibiotic therapy (Surgical & ID Referral) - Clindamycin — 600 mg — injection - Ceftriaxone — 2000 mg — injection - Vancomycin — 500 mg — injection ## Complete treatment card ```text OSTEOMYELITIS (REFERRAL) 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 against 2 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (5) - Local redness, swelling, and warmth develop at the infection site, sometimes with a dull pain that worsens with movement [redness] - Fever or chills can accompany the local symptoms [chills · fever] - The chronic form runs a longer course, usually over two weeks, with less prominent fever than the acute form [fever] - New or worsening back or neck pain with fever should raise concern for spinal osteomyelitis, especially with raised inflammatory markers or known bacteremia [back pain · fever · neck pain] - A chronic wound, especially in someone with diabetes, that fails to heal after weeks of proper care should raise concern for underlying bone infection SIGNS - what you find (2) - Tenderness over the vertebral bone on palpation can be a key finding in spinal osteomyelitis - Being able to probe an ulcer down to bone with a blunt instrument strongly suggests underlying osteomyelitis TESTS (7) - White cell count, ESR, and CRP may be raised but are not specific; CRP level tracks response to treatment - Blood cultures can be positive, particularly in blood-borne infection of the vertebrae, collarbone, or pubic bone - Plain x-rays can lag about 14 days behind the onset of infection and may miss early disease, though they help rule out other causes - A lytic lesion only becomes visible on x-ray once roughly 50 to 75 percent of the bone matrix is destroyed - MRI is the most sensitive and specific imaging test and can detect infection within 3 to 5 days of onset - A negative MRI after at least a week of symptoms is enough to rule the diagnosis out - Bone biopsy establishes the histologic diagnosis and identifies the organism to guide antibiotics; superficial wound swabs do not substitute for it IF NOT THIS - what else fits (8) - Charcot arthropathy, particularly in diabetes, is on the differential - SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis, osteitis) is on the differential - Rheumatoid and other forms of arthritis are on the differential - Metastatic bone disease is on the differential - A pathological or stress fracture is on the differential - Gout is on the differential - Avascular necrosis of the bone is on the differential - A sickle cell vaso-occlusive pain crisis is on the differential, since it can mimic bone infection Source StatPearls "Osteomyelitis" - disease-level clinical article Status traced to the source above Rx: Main treatment | Gram-negative cover | MRSA cover MAIN TREATMENT - choose one 1. EMERGENCY HOSPITAL ADMISSION AND PARENTERAL ANTIBIOTIC THERAPY (SURGICAL & ID REFERRAL)[1st line] Adult 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 - Immediate emergency referral; 6 weeks of parenteral or highly bioavailable oral therapy for most patients, 3 months for Brucella Peds Immediate emergency admission to pediatric orthopedics for parenteral antibiotic therapy and surgical drainage of subperiosteal abscess if present. Source 2015 IDSA Clinical Practice Guidelines for the Diagnosis and Treatment of Native Vertebral Osteomyelitis in Adults Why Acute osteomyelitis is a surgical and medical emergency requiring urgent hospital admission, bone biopsy/cultures, parenteral high-dose antibiotics, and potential surgical debridement. Caution 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. 2. CLINDAMYCIN [2nd line] Adult 600-900 mg IV every 8 hours, or 300-450 mg orally four times daily as targeted step-down after hospital stabilisation x 6 weeks total Peds 20-40 mg/kg/day [child max 1800 mg] (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.) 3kg -> 60-120 mg/day 4kg -> 80-160 mg/day 5kg -> 100-200 mg/day 6kg -> 120-240 mg/day 7kg -> 140-280 mg/day 8kg -> 160-320 mg/day 9kg -> 180-360 mg/day 10kg -> 200-400 mg/day 11kg -> 220-440 mg/day 12kg -> 240-480 mg/day 13kg -> 260-520 mg/day 14kg -> 280-560 mg/day 15kg -> 300-600 mg/day 16kg -> 320-640 mg/day 17kg -> 340-680 mg/day 18kg -> 360-720 mg/day 19kg -> 380-760 mg/day 20kg -> 400-800 mg/day 21kg -> 420-840 mg/day 22kg -> 440-880 mg/day 23kg -> 460-920 mg/day 24kg -> 480-960 mg/day 25kg -> 500-1000 mg/day 26kg -> 520-1040 mg/day 27kg -> 540-1080 mg/day 28kg -> 560-1120 mg/day 29kg -> 580-1160 mg/day 30kg -> 600-1200 mg/day 31kg -> 620-1240 mg/day 32kg -> 640-1280 mg/day 33kg -> 660-1320 mg/day 34kg -> 680-1360 mg/day 35kg -> 700-1400 mg/day 36kg -> 720-1440 mg/day 37kg -> 740-1480 mg/day 38kg -> 760-1520 mg/day 39kg -> 780-1560 mg/day 40kg -> 800-1600 mg/day 41kg -> 820-1640 mg/day 42kg -> 840-1680 mg/day 43kg -> 860-1720 mg/day 44kg -> 880-1760 mg/day 45kg -> 900-1800 mg/day 46kg -> 920-1800 mg/day (upper capped) 47kg -> 940-1800 mg/day (upper capped) 48kg -> 960-1800 mg/day (upper capped) 49kg -> 980-1800 mg/day (upper capped) 50kg -> 1000-1800 mg/day (upper capped) Source Egyptian National Drug Formulary - Antimicrobial 2023 Why High bone tissue penetration; preferred alternative for staphylococcal osteomyelitis in penicillin-allergic patients. Caution High risk of Clostridioides difficile-associated diarrhea; warn patient to report watery diarrhea immediately. Monitor hepatic and renal function during prolonged therapy. Egypt DALACIN C 600MG I.M./I.V. 4 ML AMP. PFIZER 148.00 EGP ALFACLINDAMYCIN 600MG/4ML 5 AMP. I.V./I.M. INJ. ALEXANDRIA > ROTABIOGEN 295.00 EGP GRAM-NEGATIVE COVER - give alongside 3. CEFTRIAXONE [add-on - not a substitute] Adult 2 g IV once daily as part of the inpatient parenteral regimen x 6 weeks total (inpatient or outpatient parenteral therapy) Peds 50-100 mg/kg/day [child max 2000 mg] (Child: 50-100 mg/kg/day IV in 1-2 divided doses (max 2000 mg daily). Hospital administration mandatory.) 3kg -> 150-300 mg/day 4kg -> 200-400 mg/day 5kg -> 250-500 mg/day 6kg -> 300-600 mg/day 7kg -> 350-700 mg/day 8kg -> 400-800 mg/day 9kg -> 450-900 mg/day 10kg -> 500-1000 mg/day 11kg -> 550-1100 mg/day 12kg -> 600-1200 mg/day 13kg -> 650-1300 mg/day 14kg -> 700-1400 mg/day 15kg -> 750-1500 mg/day 16kg -> 800-1600 mg/day 17kg -> 850-1700 mg/day 18kg -> 900-1800 mg/day 19kg -> 950-1900 mg/day 20kg -> 1000-2000 mg/day 21kg -> 1050-2000 mg/day (upper capped) 22kg -> 1100-2000 mg/day (upper capped) 23kg -> 1150-2000 mg/day (upper capped) 24kg -> 1200-2000 mg/day (upper capped) 25kg -> 1250-2000 mg/day (upper capped) 26kg -> 1300-2000 mg/day (upper capped) 27kg -> 1350-2000 mg/day (upper capped) 28kg -> 1400-2000 mg/day (upper capped) 29kg -> 1450-2000 mg/day (upper capped) 30kg -> 1500-2000 mg/day (upper capped) 31kg -> 1550-2000 mg/day (upper capped) 32kg -> 1600-2000 mg/day (upper capped) 33kg -> 1650-2000 mg/day (upper capped) 34kg -> 1700-2000 mg/day (upper capped) 35kg -> 1750-2000 mg/day (upper capped) 36kg -> 1800-2000 mg/day (upper capped) 37kg -> 1850-2000 mg/day (upper capped) 38kg -> 1900-2000 mg/day (upper capped) 39kg -> 1950-2000 mg/day (upper capped) 40kg -> 2000 mg/day (capped) 41kg -> 2000 mg/day (capped) 42kg -> 2000 mg/day (capped) 43kg -> 2000 mg/day (capped) 44kg -> 2000 mg/day (capped) 45kg -> 2000 mg/day (capped) 46kg -> 2000 mg/day (capped) 47kg -> 2000 mg/day (capped) 48kg -> 2000 mg/day (capped) 49kg -> 2000 mg/day (capped) 50kg -> 2000 mg/day (capped) AWaRe WATCH group - carries resistance cost. Egyptian EML 2025. Source 2015 IDSA Clinical Practice Guidelines for the Diagnosis and Treatment of Native Vertebral Osteomyelitis in Adults Why First-line broad-spectrum parenteral cephalosporin for Gram-negative and streptococcal osteomyelitis, combined with anti-staphylococcal therapy. Caution 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. Egypt ZOXIDEL 2 GM PD. FOR I.V. INJ. RAMEDA > DELT... 33.00 EGP EPICEPHIN 2 GM I.V. VIAL EIPICO 77.00 EGP XORAXON 2 GM I.V. VIAL MUP 83.00 EGP CEFAXONE 2 GM I.V. VIAL PHARCO B 96.00 EGP MRSA COVER - give alongside 4. VANCOMYCIN [add-on - not a substitute] Adult 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. x 6 weeks total Peds 60-80 mg/kg/day [child max 3600 mg] (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.) 3kg -> 180-240 mg/day 4kg -> 240-320 mg/day 5kg -> 300-400 mg/day 6kg -> 360-480 mg/day 7kg -> 420-560 mg/day 8kg -> 480-640 mg/day 9kg -> 540-720 mg/day 10kg -> 600-800 mg/day 11kg -> 660-880 mg/day 12kg -> 720-960 mg/day 13kg -> 780-1040 mg/day 14kg -> 840-1120 mg/day 15kg -> 900-1200 mg/day 16kg -> 960-1280 mg/day 17kg -> 1020-1360 mg/day 18kg -> 1080-1440 mg/day 19kg -> 1140-1520 mg/day 20kg -> 1200-1600 mg/day 21kg -> 1260-1680 mg/day 22kg -> 1320-1760 mg/day 23kg -> 1380-1840 mg/day 24kg -> 1440-1920 mg/day 25kg -> 1500-2000 mg/day 26kg -> 1560-2080 mg/day 27kg -> 1620-2160 mg/day 28kg -> 1680-2240 mg/day 29kg -> 1740-2320 mg/day 30kg -> 1800-2400 mg/day 31kg -> 1860-2480 mg/day 32kg -> 1920-2560 mg/day 33kg -> 1980-2640 mg/day 34kg -> 2040-2720 mg/day 35kg -> 2100-2800 mg/day 36kg -> 2160-2880 mg/day 37kg -> 2220-2960 mg/day 38kg -> 2280-3040 mg/day 39kg -> 2340-3120 mg/day 40kg -> 2400-3200 mg/day 41kg -> 2460-3280 mg/day 42kg -> 2520-3360 mg/day 43kg -> 2580-3440 mg/day 44kg -> 2640-3520 mg/day 45kg -> 2700-3600 mg/day 46kg -> 2760-3600 mg/day (upper capped) 47kg -> 2820-3600 mg/day (upper capped) 48kg -> 2880-3600 mg/day (upper capped) 49kg -> 2940-3600 mg/day (upper capped) 50kg -> 3000-3600 mg/day (upper capped) AWaRe WATCH group - carries resistance cost. Egyptian EML 2025. Source Egyptian National Drug Formulary - Antimicrobial 2023 Why Glycopeptide antibiotic providing anti-MRSA parenteral coverage in suspected or documented staphylococcal osteomyelitis. Caution 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. Egypt KEMPOVANCOM 500 MG VIAL KAHIRA > MODE... 18.00 EGP VANCOZIN 500 MG VIAL EIMC > KOREA ... 38.00 EGP VANCOMIX 500MG I.V. VIAL SIGMA TEC 79.00 EGP VANCOGUT 500 MG PD. FOR I.V. INF. VIAL ARABCOMED 95.00 EGP VANCOLON 500MG I.V. VIAL JULPHAR 95.50 EGP EDICIN 500 MG PD FOR I.V. INF. VIAL GLOBAL PHARMACEUTICAL INDUSTRIES 118.00 EGP VANCOBACT 500 MG VIAL FOR I.V. INF. ARABCOMED > EGYPHARMA 118.00 EGP VANCOMYCINE VIATRIS 500 MG VIAL VIANAX - GREE... 142.00 EGP Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)