Spinal infection: community acquired
- Urgent biopsy and/or debridement recommended with collection of specimens for culture.
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Where possible do not start antibiotics prior to urgent sampling.
- Consult Micro/ID.
- Modify treatment according to sensitivity test results. After 3 days of empiric treatment review cultures and discuss with Micro/ID.
- For culture negative results and/or ambulatory treatment discuss choices with Micro/ID
Duration: Typically, community acquired spinal infection is treated for 4-6 weeks with initial IV therapy and then oral follow-on. Discuss follow-on treatment with Micro/ID.
Preferred
flucloxacillin 2g iv qds AND gentamicin 5mg/kg iv (Gentamicin is for maximum of 3 days). Take a gentamicin level at 6-14 hours after first dose to calculate dosing interval, usually 24 hourly, 36 hourly or 48 hourly. See gentamicin monograph for dosing (including renal dosing) and monitoring.
Alternative
For penicillin allergy (non-severe)
cefazolin 2g iv tds AND gentamicin 5mg/kg iv (Gentamicin is for maximum of 3 days). Take a gentamicin level at 6-14 hours after first dose to calculate dosing interval, usually 24 hourly, 36 hourly or 48 hourly. See gentamicin monograph for dosing (including renal dosing) and monitoring.
For penicillin allergy (severe)
teicoplanin iv AND gentamicin 5mg/kg iv (Gentamicin is for maximum of 3 days). Take a gentamicin level at 6-14 hours after first dose to calculate dosing interval, usually 24 hourly, 36 hourly or 48 hourly. See gentamicin monograph for dosing (including renal dosing) and monitoring.