ROLE OF ANTIBIOTICS IN ORTHOPEDIC INFECTIONS<br />By Dr. MohdViquasuddinSaim<br />MS(ortho),PIMS<br />
osteomyelitis<br />An infection of bone most commonly caused by pyogenic bacteria and mcyobacteria.<br />Types<br />Hemato...
Microbiology of hematogenousosteomyelitis<br />Majority of cases occur in children<br />95% of cases of hematogenousosteom...
Microbiology of hematogenousosteomyelitis<br />In adults, hematogenousosteomyelitis occurs most commonly in vertebrae.<br ...
Microbiology of hematogenousosteomyelitis<br />Immunocompromised persons may develop osteomyelitis due to atypical mycobac...
Microbiology of contiguous focus osteomyelitis<br />Staph.aureus accounts for >50% cases.<br />However, these infections a...
Microbiology of contiguous focus osteomyelitis<br />Mycoplasma can cause sternalosteomyelitis after cardiac surgery.<br />...
Principles of Antibiotic therapy in osteomyelitis<br />Antibiotics should be administered only after appropriate specimens...
Principles of Antibiotic therapy in osteomyelitis<br />Guidelines for empirical therapy:<br />It should be chosen based on...
Principles of Antibiotic therapy in osteomyelitis<br />Specific therapy:<br />Its ultimately based on in-vitro susceptibil...
SUGGESTED REGIMENS<br />For Staph aureus<br />Penicillin resistant, methicillin sensitive : Nafcillin / Oxacillin 2gm IV q...
SUGGESTED REGIMENS<br />Streptococci : d.o.c Penicillin. Alternatives: cefazolin, clindamycin.<br />Gram negative bacilli ...
Septic arthritis<br />Microbiology<br />Every bacterial pathogen is capable of causing septic arthritis<br />In infants : ...
Septic arthritis<br />Microbiology <br />Infections after surgical procedures and penetrating injuries are caused by staph...
Septic arthritis<br />Rx<br />Prompt administration of systemic antibiotics and drainage of involved joint is needed.<br /...
Septic arthritis<br />Initial therapy should consist of iv adminsitration of bactericidal agents<br />Direct administratio...
Septic arthritis<br />Definitive therapy is based on identity and antibiotic susceptibilty of bacteria isolated in culture...
Gonococcal arthritis<br />Initial treatment iv ceftriaxone 1gm <br />Once local and systemic signs resolve 7 day course of...
Infections in prosthetic joints<br />Rx<br />High dose parenteral antibiotics for 4-6 weeks because bone is involved.<br /...
Role of antibiotics in gas gangrene<br />Previously the antibiotic of choice has been PenicillinG , 20 MILLION UNITS per d...
Anti TB  drugs<br />First line essential drugs<br />1. Rifampicin : most important and most potent<br />2. Isoniazid : 2nd...
Anti TB drugs<br />First line supplemental drugs<br />1. streptomycin : available for iv/ im administration only<br />2. r...
Anti TB drugs<br />Second line drugs<br />1. Quinolones : Levofloxacin and Moxifloxacin<br />2. Capreomycin<br />3. Amikac...
Newer anti TB drugs<br />LINEZOLID : can be used in drug resistant TB cases<br />Can be used iv or orally<br />
Anti TB drug regimens<br />Category I includes : spinal disease with neurological complications.<br />The treatment in Cat...
Anti TB drug regimens<br />Category III: includes sputum negative musculo-skeletal TB<br /> Category III treatment is simi...
Anti TB drug regimens<br />Category II : <br />Relapsed and treatment failure (smear-positive) cases<br />Treatment after ...
Side effects of anti TB drugs<br />Rifampicin : GI upset, hepatitis, rash, flu like syndrome and red orange urine.<br />Is...
Side effects of other antibiotics<br />Beta lactams : allergies in 1-4 % patients, diarrhea, non allergic skin reactions.<...
Side effects of other antibiotics<br />Metronidazole : metallic taste<br />Linezolid : thrombocytopenia and peripheral neu...
Thank you<br />--------The end--------------- <br />
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Role of antibiotics in orthopedic infections

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Role of antibiotics in orthopedic infections

  1. 1. ROLE OF ANTIBIOTICS IN ORTHOPEDIC INFECTIONS<br />By Dr. MohdViquasuddinSaim<br />MS(ortho),PIMS<br />
  2. 2. osteomyelitis<br />An infection of bone most commonly caused by pyogenic bacteria and mcyobacteria.<br />Types<br />Hematogenousosteomyelitis<br />Osteomyelitis secondary to contiguous focus of infection<br />Chronic osteomyelitis<br />
  3. 3. Microbiology of hematogenousosteomyelitis<br />Majority of cases occur in children<br />95% of cases of hematogenousosteomyelitis are caused by a single organism.<br />Staph.aures accounts for 50% of cases.<br />Other common pathogens are group A streptococci in children, group B streptococci and E.coli in neonates. <br />
  4. 4. Microbiology of hematogenousosteomyelitis<br />In adults, hematogenousosteomyelitis occurs most commonly in vertebrae.<br />The organisms are staph.aureus, pseudomonas, serratia and candida.<br />The most common risk factor is iv drug abuse<br />Hemoglobionopathy patients have osteomyelitis of long bones caused by salmonella and staph.aureus.<br />
  5. 5. Microbiology of hematogenousosteomyelitis<br />Immunocompromised persons may develop osteomyelitis due to atypical mycobacteria, bartonella and fungi.<br />
  6. 6. Microbiology of contiguous focus osteomyelitis<br />Staph.aureus accounts for >50% cases.<br />However, these infections are mostly polymicrobial and involve anaerobes and gram negative bacteria.<br />Staph.aureus most common cause of post operative osteomyelitis.<br />Coagulase negative staph are common pathogens after implantation of orthopaedic appliances.<br />
  7. 7. Microbiology of contiguous focus osteomyelitis<br />Mycoplasma can cause sternalosteomyelitis after cardiac surgery.<br />Pseudomonas can cause osteomyelitis after puncture wounds of foot.<br />Pasteurella.multocidaosteomyelitis follows cat bite.<br />
  8. 8. Principles of Antibiotic therapy in osteomyelitis<br />Antibiotics should be administered only after appropriate specimens have been obtained for culture.<br />use of bactericidal antibiotics is recommended.<br />Antibiotics should be given in high dose parentrally.<br />
  9. 9. Principles of Antibiotic therapy in osteomyelitis<br />Guidelines for empirical therapy:<br />It should be chosen based on findings on gram staining of a specimen from a bone or abscess.<br />Or it can be chosen to cover the most likely pathogens.(staph.aureus)<br />Empirical antibiotic therapy should also include against anaerobes in the setting of decubitis ulcer and diabetic foot.<br />
  10. 10. Principles of Antibiotic therapy in osteomyelitis<br />Specific therapy:<br />Its ultimately based on in-vitro susceptibility testing of organisms isolated from bone or blood.<br />The decision to give outpatient parenteral antimicrobial therapy is suitable for medically stable and motivated patients.<br />Parenteral therapy should be given for 5-10 days and then oral antibiotics should be used. <br />
  11. 11. SUGGESTED REGIMENS<br />For Staph aureus<br />Penicillin resistant, methicillin sensitive : Nafcillin / Oxacillin 2gm IV q4h<br />Penicillin sensitive : Penicillin 3-4 million U IV q4h<br />Methicillin resistant : Vancomycin 15mg/kg IV Q12h + Rifampicin 300mg PO q12h<br />Penicillin allergic patients : Clindamycin 900mg IV q8h / Cefazolin 1g IV q8h.<br />
  12. 12. SUGGESTED REGIMENS<br />Streptococci : d.o.c Penicillin. Alternatives: cefazolin, clindamycin.<br />Gram negative bacilli : E.coli : d.o.c : Ampicillin 2g IV q4h , alternative : Ceftriaxone… Pseudomonas : d.o.c : Piperacillin 3-4g IV / Ceftazidime 2g IV plus Tobramycin 5-7mg/kg<br />Mixed infections : Ampicillin+sulbactam, Piperacillin+tazobactam…alternative : Carbapenem+ Clindamycin.<br />
  13. 13. Septic arthritis<br />Microbiology<br />Every bacterial pathogen is capable of causing septic arthritis<br />In infants : group B Streptococci, gram negative bacilli and staph aureus.<br />Adolescents and young adults : neisseria gonorrhea is most common<br />Staph aureus most common non gonoccocal cause<br />
  14. 14. Septic arthritis<br />Microbiology <br />Infections after surgical procedures and penetrating injuries are caused by staph aureus<br />Human bites near joints and extension of decubitus ulcers cause septic arthritis due to anaerobes<br />Bites and scratches from cats introduce pasteurella into joints.<br />
  15. 15. Septic arthritis<br />Rx<br />Prompt administration of systemic antibiotics and drainage of involved joint is needed.<br />Emperical antibiotics should be started once samples of blood and synovial fluid have been obtained for culture.<br />Emperical antibiotics are given based on bacteria visualised on smears<br />
  16. 16. Septic arthritis<br />Initial therapy should consist of iv adminsitration of bactericidal agents<br />Direct administration of antibiotics into joints is not necessary<br />D.o.c: iv cefotaxime or ceftriaxone if smears show no organisms<br />Is smears show gram positive cocci : oxacillin or naficillin is used<br />If MRSA : Vancomycin<br />
  17. 17. Septic arthritis<br />Definitive therapy is based on identity and antibiotic susceptibilty of bacteria isolated in culture<br />For staph : oxacillin/ naficillin or vancomycin<br />For pneumococcal and strepto :2 weeks of penicillin<br />For H. Influenzae : cefotaxime<br />Enteric gram negative infections : ceftriaxone or fluroquinolone for 3-4 weeks<br />
  18. 18. Gonococcal arthritis<br />Initial treatment iv ceftriaxone 1gm <br />Once local and systemic signs resolve 7 day course of ciprofloaxcin can be given<br />
  19. 19. Infections in prosthetic joints<br />Rx<br />High dose parenteral antibiotics for 4-6 weeks because bone is involved.<br />A high cure rate with retention of prosthesis has been reported with the combination of oral rifampicin and ciprofloxacin for 3-6 months<br />
  20. 20. Role of antibiotics in gas gangrene<br />Previously the antibiotic of choice has been PenicillinG , 20 MILLION UNITS per day.<br />But due to increasing resistance to this drug, antibiotics inhibiting toxin synthesis appear to be favourable.<br />Clindamycin treatment enhanced survival than penicillin treatment<br />Dose of clindamycin : 600mg every 6h.<br />
  21. 21. Anti TB drugs<br />First line essential drugs<br />1. Rifampicin : most important and most potent<br />2. Isoniazid : 2nd best anti TB drug available<br />3. ethambutol : least potent amongst first line drugs<br />4. Pyrazinamide : important in short course therapy<br />
  22. 22. Anti TB drugs<br />First line supplemental drugs<br />1. streptomycin : available for iv/ im administration only<br />2. rifabutin : recommended in HIV positive individuals in place of rifampicin<br />
  23. 23. Anti TB drugs<br />Second line drugs<br />1. Quinolones : Levofloxacin and Moxifloxacin<br />2. Capreomycin<br />3. Amikacin<br />4. Ethionamide<br />5. Para-aminosalicylic acid<br />6. Cycloserine<br />
  24. 24. Newer anti TB drugs<br />LINEZOLID : can be used in drug resistant TB cases<br />Can be used iv or orally<br />
  25. 25. Anti TB drug regimens<br />Category I includes : spinal disease with neurological complications.<br />The treatment in Category I consists of an intensive phase of isoniazid (H), rifampicin (R), Pyraziamide (Z) and ethambutol (E) administered under a direct supervision thrice weekly on alternate days for 2 months (24 dosages), followed by a continuation phase of H and R thrice weekly on alternate days for 4 months (18 weeks, 54dosages). <br />The first dose of each week given directly supervised and the patient self-administering next two doses of the week, at home.<br />
  26. 26. Anti TB drug regimens<br />Category III: includes sputum negative musculo-skeletal TB<br /> Category III treatment is similar to that of Category I, but is executed without an inclusion of ethambutol.<br />
  27. 27. Anti TB drug regimens<br />Category II : <br />Relapsed and treatment failure (smear-positive) cases<br />Treatment after substantial interruption.<br />These patients are at risk of developing multidrug resistant tuberculosis (MDR-TB)<br />In category II intensive phase consists streptomycin (S), H, R, Z and E for 2 months followed by 1 month of H, R, Z and E (total 36 dosages), is administered in the same supervised manner as Category I and is followed by an appropriately supervised continuation phase consisting of 5 months (22 weeks, 66 dosages) of H, R and E.<br />
  28. 28. Side effects of anti TB drugs<br />Rifampicin : GI upset, hepatitis, rash, flu like syndrome and red orange urine.<br />Isoniazid: hepatitis, peripheral neuropathy and seizures.<br />Pyrazinamide : hepatitis, hyperuricemia and arthralgia<br />Ethambutol : optic neuritis<br />Streptomycin, amikacin and capreomycin : ototoxicity and nephrotoxicity<br />
  29. 29. Side effects of other antibiotics<br />Beta lactams : allergies in 1-4 % patients, diarrhea, non allergic skin reactions.<br />Vancomycin : red man syndrome, nephrotoxicity and ototoxicity<br />Aminoglycosides : nephrotoxicity (reversible) ,ototoxicity (irreversible)<br />Clindamycin : diarrhea due to colitis<br />Fluoroquinolones : tendon ruptures<br />
  30. 30. Side effects of other antibiotics<br />Metronidazole : metallic taste<br />Linezolid : thrombocytopenia and peripheral neuropathy.<br />
  31. 31. Thank you<br />--------The end--------------- <br />
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