TABLE 121.1 Initial Antibiotic Therapy: Osteomyelitis a Age Pathogens Antibiotics Neonate 2 mo–5 yrs >5 yrs Special cases Sickle cell disease Foot puncture wound Clindamycin b , c Clindamycin c Salmonella, S aureus Clindamycin and ceftriaxone Pseudomonas aeruginosa, S Cefepime or aureus piperacillin/tazobactam a Coverage modified on the basis of culture results and sensitivities ceftriaxone for Gram stain without gram-positive cocci or PCR or culture positive for Kingella kingae c Vancomycin if high incidence of clindamycin resistance in community or ill appearance b Add Certain groups are at risk for particular organisms Patients with sickle cell disease have a high incidence of osteomyelitis caused by salmonella Pseudomonas aeruginosa is a common organism found in osteomyelitis of the foot, often resulting from a nail penetrating a sneaker Clinical Indications for Discharge or Admission Initial therapy for osteomyelitis includes hospital admission with intravenous antibiotics and pain control Empiric antibiotic therapy is based on the predominant organisms in each age group, local sensitivity patterns, the mechanism of infection, and Gram stain results Clindamycin is the treatment of choice for osteomyelitis outside of the neonatal age range when MRSA is suspected Vancomycin may be indicated for empiric treatment when the incidence of clindamycin resistance in the community is high or the patient is