Treatment of Osteomyelitis with Daptomycin and Meropenem

Assessment and Treatment

• The Infectious Diseases Society of America (IDSA) recommends daptomycin as an effective alternative to vancomycin for bone and joint infections due to MRSA, with a proposed dose of 650 mg IV Q24h being appropriate for osteomyelitis treatment 1
• Meropenem is recommended by IDSA for the treatment of osteomyelitis due to Pseudomonas aeruginosa or Enterobacteriaceae, with a proposed dose of 1000 mg IV Q8h being appropriate for osteomyelitis treatment 1
• The combination of daptomycin and meropenem provides broad-spectrum coverage for both gram-positive and gram-negative pathogens in the absence of culture data, particularly in traumatic osteomyelitis where polymicrobial infection is possible 1, 2
• A 6-week course of antibiotics is standard of care for osteomyelitis without complete surgical debridement, with weekly monitoring of CBC, CMP, CRP, sed rate, and CK to assess response to therapy and monitor for adverse effects 1
• CRP and ESR are useful markers to monitor response to therapy in osteomyelitis 1
• If cultures become available during treatment, therapy should be narrowed to target the specific pathogens identified, and consideration should be given to adding rifampin if Staphylococcus species are identified to enhance bone penetration and biofilm activity 1