Gram-positive bacteria
For superficial surgical site infection, if Gram-positive bacteria are suspected (eg the procedure did not enter the gastrointestinal, respiratory or genitourinary tracts), 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. See below for duration of therapy 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. See below for duration of therapy. flucloxacillin flucloxacillin flucloxacillin
Cefalexin is often preferred to dicloxacillin or flucloxacillin in children, because the liquid formulation is better tolerated. It can also be used for patients who have had a nonsevere (immediate or delayed) hypersensitivity reaction to a penicillin1. Use:
1cefalexin 500 mg (child: 12.5 mg/kg up to 500 mg) orally, 6-hourly. For dosage adjustment in adults with kidney impairment, see cefalexin dosage adjustment. See below for duration of therapy cefalexin cefalexin cefalexin
OR if adherence to a 6-hourly regimen is unlikely in a child
1cefalexin 20 mg/kg up to 750 mg orally, 8-hourly2. See below for duration of therapy. cefalexin cefalexin cefalexin
For patients who have had a severe (immediate or delayed)3 hypersensitivity reaction to a penicillin, use:
clindamycin 450 mg (child: 10 mg/kg up to 450 mg) orally, 8-hourly. See below for duration of therapy. clindamycin clindamycin clindamycin
Modify therapy based on the results of culture and susceptibility testing.
Duration of therapy: continue antibiotic therapy for 5 days; a longer duration may be required depending on clinical response. If there is a poor response to empirical therapy, review whether the pathogen is adequately treated and re-evaluate the wound for evidence of deeper tissue involvement.