Oral continuation therapy for acute suppurative sialadenitis
When patients with acute suppurative sialadenitis are able to swallow, switch to oral therapy for a total of 10 days (intravenous + oral). If the results of culture and susceptibility testing are available, modify oral therapy accordingly. If results of susceptibility testing are not available, use the regimens for intravenous to oral switch below.
For adults and children with risk factors for MRSA infection for whom results of susceptibility testing are not available, use:
1trimethoprim+sulfamethoxazole 160+800 mg (child 1 month or older: 4+20 mg/kg up to 160+800 mg) orally, 12-hourly. For dosage adjustment in adults with kidney impairment, see trimethoprim+sulfamethoxazole dosage adjustment trimethoprim + sulfamethoxazole trimethoprim+sulfamethoxazole trimethoprim+sulfamethoxazole
OR
2clindamycin 450 mg (child: 10 mg/kg up to 450 mg) orally, 8-hourly1. clindamycin clindamycin clindamycin
For adults and children without risk factors for MRSA infection for whom results of susceptibility testing are not available, use:
1dicloxacillin 500 mg (child: 12.5 mg/kg up to 500 mg) orally, 6-hourly. For dosage adjustment in adults with kidney impairment, see dicloxacillin dosage adjustment dicloxacillin dicloxacillin dicloxacillin
OR
1flucloxacillin 500 mg (child: 12.5 mg/kg up to 500 mg) orally, 6-hourly. For dosage adjustment in adults with kidney impairment, see flucloxacillin oral dosage adjustment. flucloxacillin flucloxacillin flucloxacillin
For adults without risk factors for MRSA infection who have had a hypersensitivity reaction to a penicillin and tolerated initial 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, use:
cefalexin 500 mg orally, 6-hourly. For dosage adjustment in adults with kidney impairment, see cefalexin dosage adjustment. cefalexin cefalexin cefalexin
For children without risk factors for MRSA infection who have had a hypersensitivity reaction to a penicillin and tolerated initial cefazolin therapy, cefalexin can be used2; however, cefalexin must not be used if the child has had a severe (immediate or delayed)3 hypersensitivity reaction to amoxicillin or ampicillin. If cefalexin is appropriate, use:
1cefalexin 12.5 mg/kg up to 500 mg orally, 6-hourlycefalexin
OR (if adherence to a 6-hourly regimen is unlikely)
1cefalexin 20 mg/kg up to 750 mg, orally 8-hourly4.cefalexin
For adults and children who have had a severe immediate hypersensitivity reaction to amoxicillin or ampicillin or severe delayed5 hypersensitivity reaction to any penicillin, use trimethoprim+sulfamethoxazole or clindamycin (as above).