Ongoing management of MSSA native bone or joint infection
The suggested duration of antibiotic therapy and timing of oral switch for adults and children with methicillin-susceptible Staphylococcus aureus (MSSA) native bone or joint infection depends on whether the patient has osteomyelitis or septic arthritis.
For MSSA osteomyelitis or septic arthritis in adults and children, when it is appropriate to switch to oral therapy, use:
1dicloxacillin 1 g (child: 25 mg/kg up to 1 g) orally, 6-hourly. For dosage adjustment in adults with kidney impairment, see dicloxacillin dosage adjustment dicloxacillin dicloxacillin dicloxacillin
OR
1flucloxacillin 1 g (child: 25 mg/kg up to 1 g) orally, 6-hourly. For dosage adjustment in adults with kidney impairment, see flucloxacillin oral dosage adjustment. flucloxacillin flucloxacillin flucloxacillin
Cefalexin is often preferred to oral dicloxacillin or flucloxacillin in children because the liquid formulation is better tolerated (see dosages below).
For adults and children who have had a hypersensitivity reaction to a penicillin who tolerated initial cefazolin therapy, cefalexin can be used1; however, cefalexin must not be used if the patient has had a severe (immediate or delayed)2 hypersensitivity reaction to amoxicillin or ampicillin. If cefalexin is appropriate, 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-hourly3.
For patients who have had a severe immediate4 hypersensitivity reaction to amoxicillin or ampicillin or severe delayed5 hypersensitivity reaction to any penicillin, use:
clindamycin 450 mg (child: 10 mg/kg up to 450 mg) orally, 8-hourly. clindamycin clindamycin clindamycin
For patients initially treated with vancomycin, seek expert advice on choice of oral therapy and timing of switch.