Ongoing management of Kingella kingae native bone or joint infection

The suggested duration of antibiotic therapy and timing of oral switch for adults and children with Kingella kingae native bone or joint infection depends on whether the patient has osteomyelitis or septic arthritis.

For patients with osteomyelitis or septic arthritis caused by K. kingae, without susceptibility results or with benzylpenicillin resistance, when it is appropriate to switch to oral therapy, use:

1cefalexin 1 g (child: 25 mg/kg up to 1 g) orally, 6-hourly. For dosage adjustment in adults with kidney impairment, see cefalexin dosage adjustment cefalexin cefalexin cefalexin

OR (if adherence to a 6-hourly regimen is unlikely in a child)

1cefalexin 45 mg/kg up to 1.5 g orally, 8-hourly¹.

For patients with osteomyelitis or septic arthritis caused by benzylpenicillin-susceptible K. kingae, when it is appropriate to switch to oral therapy, amoxicillin is the drug of choice for susceptible isolates. Use:

amoxicillin 1 g (child: 25 mg/kg up to 1 g) orally, 8-hourly. For dosage adjustment in adults with kidney impairment, see amoxicillin dosage adjustment. amoxicillin amoxicillin amoxicillin

For patients who have had a hypersensitivity reaction to a penicillin who tolerated cefazolin therapy, cefalexin can be used²; however, cefalexin must not be used if the patient has had a severe (immediate or delayed)³ hypersensitivity reaction to amoxicillin or ampicillin. If cefalexin is appropriate, see dosages above.

For patients who have had a severe immediate⁴ hypersensitivity reaction to amoxicillin or ampicillin or severe delayed⁵ hypersensitivity reaction to any penicillin, seek expert advice.

¹ The 8-hourly dosage regimen for cefalexin is supported by pharmacokinetic, pharmacodynamic and clinical dataAutmizguine, 2013 Gwee, 2020 Ramchandar, 2020 Yu, 2022.Return

² Cefalexin may be used in patients who have had a nonsevere (immediate or delayed) reaction to amoxicillin or ampicillin. However, because cross-reactivity between these drugs is possible, consideration should be given to the extent of the reaction, patient acceptability, and the suitability of non–beta-lactam options.Return

³ Severe immediate hypersensitivity reactions include anaphylaxis, compromised airway, airway angioedema, hypotension and collapse. Severe delayed hypersensitivity reactions include cutaneous adverse drug reactions (eg drug rash with eosinophilia and systemic symptoms [DRESS], Stevens–Johnson syndrome/toxic epidermal necrolysis [SJS/TEN], severe blistering or desquamative rash), and significant internal organ involvement (eg acute interstitial nephritis).Return

⁴ Severe immediate hypersensitivity reactions include anaphylaxis, compromised airway, airway angioedema, hypotension and collapse.Return

⁵ Severe delayed hypersensitivity reactions include cutaneous adverse drug reactions (eg drug rash with eosinophilia and systemic symptoms [DRESS], Stevens–Johnson syndrome/toxic epidermal necrolysis [SJS/TEN], severe blistering or desquamative rash), and significant internal organ involvement (eg acute interstitial nephritis).Return