Spinal infection: post-surgical or post instrumentation
- Urgent biopsy and/or debridement recommended with collection of specimens for culture.
- Consult Micro/ID
- Modify treatment according to sensitivity test results.
- For culture negative results and/or ambulatory treatment discuss choices with Micro/ID.
Preferred (including penicillin allergy non-severe)
ceftazidime 2g iv tds (If patient is over 80 years of age the usual daily maximum dose of ceftazidime is 3g; this can be increased to 6g daily on advice documented by Micro/ID Consultant)
AND
linezolid 600mg po bd (iv if NBM) (See linezolid drug monograph for information about monitoring required)
If unable to have linezolid: substitute linezolid with teicoplanin iv
Alternative
For penicillin allergy (severe)
linezolid 600mg po (iv if NBM) bd (See linezolid drug monograph for information about monitoring required)
If unable to have linezolid: substitute linezolid with teicoplanin iv
PLUS EITHER
Aztreonam 2g iv qds (in patients with a history of penicillin or cephalosporin allergy, aztreonam may be administered without prior testing unless there is a history of ceftazidime allergy)
OR
Ciprofloxacin* 500mg po bd (400mg iv bd if NBM)
Ciprofloxacin may induce seizures in patients with or without a history of seizures – use with caution
*Ensure that the patient is given the Fluoroquinolone MHRA patient information leaflet.
Fluoroquinolones, including ciprofloxacin, are associated with disabling and potentially long-lasting or irreversible side effects. See Fluoroquinolone antibiotics - severe adverse effects.