ORT 1.2 Acute osteomyelitis - Staphylococcus aureus

Content version: U-18.2
Updated: 10/20/2025 - 12:42

Recommendations

≥ 18 years
	Dosage	Remarks
	flucloxacillin IV 6 g/24 h	Loading dose 1 gram flucloxacillin bolus, then continuous infusion (If continuous infusion is not possible, then flucloxacillin 1 g six times daily)

≥ 18 years

Indications: Allergy to penicillins*
	Dosage	Remarks
	cefazolin IV 2000 mg three times daily for 6 weeks	Non-severe penicillin allergy
	clindamycin PO 600 mg three times daily for 6 weeks	Beta-lactam allergy

Comments

*See protocol Policy for antibiotic allergy | Radboud UMC

Without bacteraemia:

Total duration of antibiotics in an uncomplicated course: 6 weeks
At least 1 week of intravenous treatment
With proven susceptibility, once a good clinical response is achieved, switch to oral therapy with clindamycin 600 mg three times daily. In clindamycin resistance, cotrimoxazole 960 mg twice daily orally or flucloxacillin 1000 mg four times daily orally are alternatives

With bacteraemia:

Treat intravenously for at least two weeks and longer depending on other metastatic foci (for example endocarditis)
Request a bedside consultation with an infectious disease specialist