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Recommendations

≥ 18 years
Dosage Remarks
1st choice
flucloxacillin IV 12 g continuous per 24 hours

+

rifampicin oral 450 mg twice daily

If susceptibility is confirmed

Loading dose: 2 g flucloxacillin bolus, then continuous infusion

(If continuous infusion is not possible, then flucloxacillin 2 g six times daily)

2nd choice
teicoplanin IV

+

rifampicin oral 450 mg twice daily

For loading and maintenance dosing, see teicoplanin

≥ 18 years

Indications: oral switch

Dosage Remarks
1st choice
clindamycin oral 600 mg three times daily

+

rifampicin oral 450 mg twice daily
2nd choice
cotrimoxazole (trimethoprim + sulfamethoxazole) oral 960 mg twice daily

+

rifampicin oral 450 mg twice daily
3rd choice

In case of resistance to clindamycin and cotrimoxazole: consult a microbiologist or infectious disease specialist.

Comments

Add rifampicin only in DAIR or 1-stage exchange. Not in 2-stage exchange or chronic suppressive therapy

Add rifampicin as soon as staphylococci have been identified. If these prove resistant to rifampicin, discontinue rifampicin.

Reduce rifampicin dose to 300 mg twice daily in case of adverse effects