Empiric Antibiotics and Laboratory Monitoring for Musculoskeletal Infection

Discuss with ID prior to initiation
Order an add-on test for baseline BMP and LFTs (to aid in antibiotic dosing)

  IV

   Clindamycin 13 mg/kg/dose IV q8hrs
   (Max: 900 mg/dose) 
   especially if concern for MRSA

   Cefazolin 50 mg/kg/dose IV q8hrs
   (Max: 2000 mg/dose)
   especially if concern for Kingella kingae

  PO*

   Clindamycin 10 - 13 mg/kg/dose PO TID
   (Max: 600 mg/dose)

   especially if concern for MRSA

   Cephalexin 33 - 50 mg/kg/dose PO q8hrs
   (Max: 1500 mg/dose)
   especially if concern for Kingella kingae

Recommended frequency of laboratory monitoring for MSK Infection:

 CRP: If CRP > 3 mg/dL initially, recheck no more than every 2-3 days until > 50% reduction, and then once weekly. If CRP ≤ 3 mg/dL initially, then just check once weekly.

 ESR: Obtain ESR at the start of therapy and toward the end of therapy if > 20 mm/hr.

 CBC: Obtain CBC with diff at the start of therapy and when transitioning to oral therapy if WBC count initially elevated.