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Ceftriaxone for Methicillin-Sensitive Staphylococcus aureus Osteoarticular Infections: A Survey of Infectious Disease Physicians’ Attitudes and Review of the Literature

Sharff, Katie A. MD*; Graber, Christopher J. MD; Spindel, Steven J. MD; Nguyen, Hien M. MD

Infectious Diseases in Clinical Practice: May 2014 - Volume 22 - Issue 3 - p 132–140
doi: 10.1097/IPC.0000000000000109
Review Articles

The use of ceftriaxone for methicillin-sensitive Staphylococcus aureus (MSSA) osteoarticular infections in outpatient antimicrobial therapy remains controversial. Our informal survey of 135 academic and community infectious disease physicians suggests that only 96 (71.1%) are willing to use ceftriaxone for MSSA osteoarticular infections, 55 of which use it only infrequently (ie, 1%–19% of the time). Among the ceftriaxone users, most believe that there is a role for ceftriaxone in acute osteomyelitis (82.2%), chronic osteomyelitis (63.3%), osteomyelitis with uncomplicated bacteremia (61.1%), vertebral osteomyelitis (57.8%), and prosthetic infections (51.1%). We reviewed the clinical literature and analyzed ceftriaxone pharmacokinetics-pharmacodynamics to construct a clinical framework to optimally use ceftriaxone in osteoarticular infections. We conclude that ceftriaxone may be a reasonable therapeutic option for acute, uncomplicated MSSA osteoarticular infections after adequate surgical debridement, particularly when ceftriaxone is given as 2 g daily for MSSA isolates with oxacillin minimal inhibitory concentration values of 0.5 μg/mL or less (corresponding to ceftriaxone minimal inhibitory concentration values of ≤4 μg/mL).

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From the *Division of Infectious Diseases, Oregon Health and Sciences University, Portland, OR; †Infectious Diseases Section, VA Greater Los Angeles Healthcare System, David Geffen School of Medicine at the University of California, Los Angeles, CA and ‡Department of Infectious Diseases, Northwest Permanente, Portland, OR.

Correspondence to: Hien M. Nguyen, MD, Department of Infectious Diseases, Northwest Permanente, 9900 SE Sunnyside Rd, Clackamas, OR 97015. E-mail:

The authors have no funding or conflicts of interest to disclose.

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© 2014 by Lippincott Williams & Wilkins.