Diskitis Medication

  • Author: George I Jallo, MD; Chief Editor: Mary Ann E Keenan, MD   more...
 
Updated: Feb 9, 2011
 

Medication Summary

Parenteral narrow-spectrum antibiotics should be prescribed according to the organism isolated. If cultures are consistently negative, administer broad-spectrum antibiotics for several weeks.

Next

Antibiotics

Class Summary

Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting.

View full drug information

Vancomycin (Lyphocin, Vancocin, Vancoled)

 

Potent antibiotic that is directed against gram-positive organisms and is active against Enterococcus species. Useful in the treatment of septicemia and skin structure infections. Indicated for patients who cannot receive or have failed to respond to penicillins or cephalosporins or who have infections with resistant staphylococci. For abdominal penetrating injuries, it is combined with an agent active against enteric flora and/or anaerobes.

To avoid toxicity, the current recommendation is to assay vancomycin trough levels after the third dose is drawn and a half an hour prior to the next dose. Use CrCl to adjust the dosage in patients diagnosed with renal impairment.

Used in conjunction with gentamicin for prophylaxis in patients who are allergic to penicillin and are undergoing gastrointestinal or genitourinary procedures.

View full drug information

Gentamicin (Garamycin, Gentacidin)

 

Aminoglycoside antibiotic for gram-negative coverage. Used in combination with both an agent against gram-positive organisms and one that covers anaerobes. Not the drug of choice (DOC). Consider if penicillins or other less toxic drugs are contraindicated, in mixed infections caused by susceptible staphylococci and gram-negative organisms, or when clinically indicated.

Dosing regimens are numerous; adjust dose based on CrCl and changes in volume of distribution. May be given IV/IM.

View full drug information

Nafcillin (Unipen, Nallpen, Nafcil)

 

Initial therapy for suspected penicillin-G–resistant streptococcal or staphylococcal infections. Use parenteral therapy initially for severe infections. Change to oral therapy as condition warrants.

Due to thrombophlebitis, particularly in the elderly, administer parenterally only for short term (1-2 d); change to oral route as clinically indicated.

View full drug information

Ceftazidime (Tazidime, Tazicef, Ceptaz, Fortaz)

 

Third-generation cephalosporin with broad-spectrum, gram-negative activity; lower efficacy against gram-positive organisms; higher efficacy against resistant organisms. Arrests bacterial growth by binding to one or more penicillin-binding proteins.

Previous
Proceed to Follow-up
 
 
Contributor Information and Disclosures
Author

George I Jallo, MD  Associate Professor of Neurosurgery, Pediatrics and Oncology, Director, Clinical Pediatric Neurosurgery, Department of Neurosurgery, Johns Hopkins University School of Medicine

George I Jallo, MD is a member of the following medical societies: American Association of Neurological Surgeons, American Medical Association, and American Society of Pediatric Neurosurgeons

Disclosure: Codman (Johnson & Johnson) Grant/research funds Consulting; Medtronic Grant/research funds Consulting

Coauthor(s)

Alvin Marcovici, MD  Consulting Staff, Southcoast Neurosurgery

Alvin Marcovici, MD is a member of the following medical societies: American Association of Neurological Surgeons, Congress of Neurological Surgeons, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Specialty Editor Board

K Daniel Riew, MD  Mildred B Simon Distinguished Professor of Orthopedic Surgery, Professor of Neurologic Surgery, Washington University School of Medicine; Chief, Cervical Spine Surgery, Department of Orthopedic Surgery, Barnes-Jewish Hospital

K Daniel Riew, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, AO Foundation, Cervical Spine Research Society, North American Spine Society, and Scoliosis Research Society

Disclosure: Medtronic Royalty Medtronic Vertex; Biomet Royalty Maxan anterior cervical plate; Osprey Royalty Interbody Graft; Osprey Stock Options None; SpineMedica None None; Synthes Consulting fee Other

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

William O Shaffer, MD  Professor, Vice-Chairman and Residency Program Director, Department of Orthopedic Surgery, University of Kentucky at Lexington

William O Shaffer, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, International Society for the Study of the Lumbar Spine, Kentucky Medical Association, Kentucky Orthopaedic Society, North American Spine Society, Southern Medical Association, and Southern Orthopaedic Association

Disclosure: DePuySpine 1997-2007 (not presently) Royalty Consulting; DePuySpine 2002-2007 (closed) Grant/research funds SacroPelvic Instrumentation Biomechanical Study; DePuyBiologics 2005-2008 (closed) Grant/research funds Healos study just closed; DePuySpine 2009 Consulting fee Design of Offset Modification of Expedium

Dinesh Patel, MD, FACS  Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital

Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Chief Editor

Mary Ann E Keenan, MD  Professor, Vice Chair for Graduate Medical Education, Department of Orthopedic Surgery, University of Pennsylvania School of Medicine; Chief of Neuro-Orthopedics Program, Department of Orthopedic Surgery, Hospital of the University of Pennsylvania

Mary Ann E Keenan, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, American Society for Surgery of the Hand, and Orthopaedic Rehabilitation Association

Disclosure: Nothing to disclose.

References

  1. Conaughty JM, Chen J, Martinez OV, et al. Efficacy of linezolid versus vancomycin in the treatment of methicillin-resistant Staphylococcus aureus discitis: a controlled animal model. Spine. Oct 15 2006;31(22):E830-2. [Medline].

  2. Hooten WM, Mizerak A, Carns PE, Huntoon MA. Discitis after lumbar epidural corticosteroid injection: a case report and analysis of the case report literature. Pain Med. Jan-Feb 2006;7(1):46-51. [Medline].

  3. Walters R, Rahmat R, Fraser R, Moore R. Preventing and treating discitis: cephazolin penetration in ovine lumbar intervertebral disc. Eur Spine J. Sep 2006;15(9):1397-403. [Medline].

  4. Martínez Hernández PL, Amer López M, Zamora Vargas F, García de Paso P, Navarro San Francisco C, Pérez Fernández E, et al. [Spontaneous infectious spondylodiscitis in an internal medicine department: epidemiological and clinical study in 41 cases]. Rev Clin Esp. Jul-Aug 2008;208(7):347-52. [Medline].

  5. Cottle L, Riordan T. Infectious spondylodiscitis. J Infect. Jun 2008;56(6):401-12. [Medline].

  6. Sharma SK, Jones JO, Zeballos PP, Irwin SA, Martin TW. The prevention of discitis during discography. Spine J. Jul 28 2009;[Medline].

  7. Maus U, Andereya S, Gravius S, Ohnsorge JA, Miltner O, Niedhart C. [Procalcitonin (PCT) as diagnostic tool for the monitoring of spondylodiscitis]. Z Orthop Unfall. Jan-Feb 2009;147(1):59-64. [Medline].

  8. Karadimas EJ, Bunger C, Lindblad BE, Hansen ES, Høy K, Helmig P, et al. Spondylodiscitis. A retrospective study of 163 patients. Acta Orthop. Oct 2008;79(5):650-9. [Medline].

  9. Eguchi Y, Ohtori S, Yamashita M, Yamauchi K, Suzuki M, Orita S, et al. Diffusion magnetic resonance imaging to differentiate degenerative from infectious endplate abnormalities in the lumbar spine. Spine (Phila Pa 1976). Feb 1 2011;36(3):E198-202. [Medline].

  10. Bileckot R, Ntsiba H, Okongo D. [Diagnosis of arthritis in black Africa. Apropos of 473 cases in Congo]. Rev Rhum Ed Fr. Apr 1994;61(4):260-5. [Medline].

  11. Bontoux D, Codello L, Debiais F. [Infectious spondylodiscitis. Analysis of a series of 105 cases]. Rev Rhum Mal Osteoartic. Jun 1992;59(6):401-7. [Medline].

  12. Borowski AM, Crow WN, Hadjipavlou AG. Interventional radiology case conference: the University of Texas Medical Branch. Percutaneous management of pyogenic spondylodiskitis. AJR Am J Roentgenol. Jun 1998;170(6):1587-92. [Medline].

  13. Bwanahali K, Dikilu K, Kilesi M. [Etiologic aspects of low back pain in rheumatic patients in Kinshasa (Zaire). Apropos of 169 cases]. Rev Rhum Mal Osteoartic. Apr 1992;59(4):253-7. [Medline].

  14. Ehara S. Spondylodiskitis. AJR Am J Roentgenol. May 1999;172(5):1450-1. [Medline].

  15. Fouquet B, Goupille P, Jattiot F. Discitis after lumbar disc surgery. Features of "aseptic" and "septic" forms. Spine. Mar 1992;17(3):356-8. [Medline].

  16. Hadjipavlou AG, Cesani-Vazquez F, Villaneuva-Meyer J. The effectiveness of gallium citrate Ga 67 radionuclide imaging in vertebral osteomyelitis revisited. Am J Orthop. Mar 1998;27(3):179-83. [Medline].

  17. Hopf C, Meurer A, Eysel P. Operative treatment of spondylodiscitis--what is the most effective approach?. Neurosurg Rev. 1998;21(4):217-25. [Medline].

  18. Houten JK, Cooper PR. Pyogenic osteomyelitis of the spine. Contemporary Neurosurgery. 2000;22:6:1-8.

  19. Jimenez-Mejias ME, de Dios Colmenero J, Sanchez-Lora FJ. Postoperative spondylodiskitis: etiology, clinical findings, prognosis, and comparison with nonoperative pyogenic spondylodiskitis. Clin Infect Dis. Aug 1999;29(2):339-45. [Medline].

  20. Kemp HB, Jackson JW, Jeremiah JD. Pyogenic infections occurring primarily in intervertebral discs. J Bone Joint Surg [Br]. Nov 1973;55(4):698-714. [Medline].

  21. Khan IA, Vaccaro AR, Zlotolow DA. Management of vertebral diskitis and osteomyelitis. Orthopedics. Aug 1999;22(8):758-65. [Medline].

  22. King HA. Back pain in children. Orthop Clin North Am. Jul 1999;30(3):467-74, ix. [Medline].

  23. Kylanpaa-Back ML, Suominen RA, Salo SA. Postoperative discitis: outcome and late magnetic resonance image evaluation of ten patients. Ann Chir Gynaecol. 1999;88(1):61-4. [Medline].

  24. Maiuri F, Iaconetta G, Gallicchio B. Spondylodiscitis. Clinical and magnetic resonance diagnosis. Spine. Aug 1 1997;22(15):1741-6. [Medline].

  25. Maliner LI, Johnson DL. Intervertebral disc space inflammation in children. Childs Nerv Syst. Feb 1997;13(2):101-3; discussion 104. [Medline].

  26. McCain GA, Harth M, Bell DA. Septic Discitis. J Rheumatol. Jan-Feb 1981;8(1):100-9. [Medline].

 
Previous
Next
 
Axial CT scan in a patient with diskitis demonstrates extensive destruction of the vertebral endplate. Note the preservation of the posterior elements, including facet joints, lamina, and spinous process. This is characteristic for pyogenic diskitis and less common in tuberculosis (Pott disease).
Sagittal T1-weighted MRI of the lumbar spine in a 74-year-old man, revealing diskitis of the L4-L5 disk space. Note extensive destruction of the endplates of the adjacent vertebral bodies. No compression of the thecal sac is present, which is an important consideration when contemplating surgical intervention.
Contrast-enhanced sagittal T1-weighted MRI image in a 55-year-old woman shows thoracic diskitis with an associated epidural abscess and spinal cord compression. Because of the significant cord compression, this patient underwent surgical decompression.
Trajectory of a needle in a biopsy of the infected disk space guided by CT scan. Care is taken to avoid the thecal sac and nerve roots.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.