Intravenous to oral switch for methicillin- and penicillin-susceptible Staphylococcus aureus pneumonia

For patients with methicillin- or penicillin- susceptible Staphylococcus aureus pneumonia and bacteraemia, see Staphylococcus aureus bacteraemia, including sepsis and septic shock for ongoing management.

If bacteraemia has been excluded, consider switching to oral therapy once the patient improves (for guidance on when to switch to oral therapy, see Guidance for intravenous to oral switch).

For adults and children with methicillin-susceptible S. aureus (MSSA) pneumonia, use:

flucloxacillin 1 g (child: 25 mg/kg up to 1 g) orally or enterally, 6-hourly. For dosage adjustment in adults with kidney impairment, see flucloxacillin oral dosage adjustment. See advice on duration of therapy. flucloxacillin flucloxacillin flucloxacillin

Cefalexin is often preferred to flucloxacillin in children, because the liquid formulation is better tolerated. For children with MSSA pneumonia, use:

1cefalexin 25 mg/kg up to 1 g orally or enterally, 6-hourly. See advice on duration of therapy cefalexin

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

1cefalexin 45 mg/kg up to 1.5 g, orally 8-hourly. See advice on duration of therapy.

For patients who report hypersensitivity to a penicillin, seek expert advice.

For penicillin-susceptible S. aureus (PSSA) pneumonia, seek expert advice for intravenous to oral switch.