Do you recommend a prolonged duration of antibiotics and/or suppression for patients without pre-existing hardware who have placement of new hardware after decompression/washout of a Staphylococcus aureus epidural abscess?

This can be a difficult clinical scenario and the answer depends in part on whether there was any concern for osteomyelitis at the time the epidural abscess was drained. If so, I would suggest giving a prolonged duration of abx with 6 weeks of targeted IV abx therapy and oral Rifampin followed by 3 ...

If the hardware is placed in the setting of active infection, then I usually chronically suppress the patient indefinitely after treating for the acute infection.

I usually plan 12 weeks of treatment, and then a risk/benefit discussion with the patient about the ongoing antibiotic. There was a retrospective review about 10 years ago (Park et al., PMID 25663159) about the duration of antibiotics with instrumented hematogenous vertebral osteomyelitis. Numbers w...

I recommend 12 weeks of antimicrobial therapy following instrumentation for instability secondary to spondylodiscitis. Evidence from this paper suggests that longer courses (>8 weeks) are associated with better outcomes than shorter courses (<4 weeks). It is important to note that subsequent suppres...