Flucloxacillin

Flucloxacillin is a penicillin that resists the beta-lactamase enzyme made by Staphylococcus aureus, which is why it is the usual choice for staph skin infection (DermNet). NICE NG190 makes it the first-choice oral antibiotic for secondary bacterial infection of eczema, for 5–7 days (125–250 mg four times daily for ages 2–9). It is used only when the child is systemically unwell or the infection is widespread or severe. It does not work against MRSA. Clarithromycin is the alternative for penicillin allergy.

Flucloxacillin [treats] Infected Eczema Flucloxacillin [treats] Staphylococcus aureus NICE NG190 [regulates] Flucloxacillin MRSA [opposes] Flucloxacillin

Paediatric dosing context. Both NICE antimicrobial guidelines dose children by age band: 1 month–1 year, 62.5–125 mg; 2–9 years, 125–250 mg; 10–17 years, 250–500 mg, four times a day. NICE NG190 gives 5–7 days for infected eczema and NICE NG153 gives 5 days for Impetigo, extendable to 7. NICE notes the bands assume an average-sized child and that some doses are off-label (BNFC). Medicines for Children advises giving it four times a day, ideally before meals, at least 3 hours apart. Liquid should be measured with an oral syringe, never a kitchen spoon. If the child vomits within 30 minutes, give the dose again. Improvement is expected within 2–3 days, and the full course should be finished. NG190 itself stresses that in a well child antibiotics add little to Topical Corticosteroids. A Cochrane review found no clear benefit of oral antibiotics over placebo in children with clinically infected eczema (George et al. 2019, low-quality evidence).

NICE NG153 [regulates] Flucloxacillin Flucloxacillin [treats] Impetigo Cochrane [contradicts] Flucloxacillin

Conflict: [NICE NG190, 2021-03] names oral flucloxacillin first choice for a child with infected eczema who is systemically unwell or has widespread infection. [Cochrane, George et al., 2019-10] found no clear benefit of oral antibiotics over placebo in children with clinically infected eczema (low-quality evidence, small trials). NICE limits use to unwell or severe cases, which the trials largely did not test. Unresolved — add to open_questions.

Taste and adherence. Poor palatability of the oral solution is a recognised problem. NICE NG153 says that if the solution “is not tolerated because of poor palatability”, consider capsules, and links to the Medicines for Children guidance on teaching a child to swallow tablets. If an oral solution is unpalatable and the child cannot swallow capsules, Clarithromycin is an acceptable alternative. The four-times-daily, before-food schedule is hard to keep around nursery. Medicines for Children says to give a missed pre-meal dose during or straight after the meal, and never a double dose. This round found no parent-community sources on taste workarounds; that gap is logged in open_questions.

Flucloxacillin [relates] Clarithromycin

Penicillin allergy alternatives. Flucloxacillin is a penicillin and must not be given to a child with penicillin allergy (Medicines for Children). The NICE alternative in non-pregnant patients is Clarithromycin, dosed by weight in children (8–11 kg: 62.5 mg; 12–19 kg: 125 mg twice daily). Erythromycin is the macrolide preferred in pregnancy. If MRSA is suspected or confirmed, both guidelines say to consult a microbiologist. Medicines for Children lists the warning signs needing an ambulance: swelling of face/lips/tongue, rash, breathing difficulty. Jaundice or prolonged/bloody diarrhoea in the month after the course should be reported, because flucloxacillin “may very occasionally cause liver or bowel problems”.

Clarithromycin [relates] Flucloxacillin Erythromycin [relates] Flucloxacillin

What parents report (evidence: anecdotal). Parents describe repeated bacterial infections when eczema stays uncontrolled: “3 skin infections later and 3 lots of antibiotics” (r/ScienceBasedParenting). Others describe a hospital admission at 3 months, or a staph infection needing a wound specialist (r/eczema). Several regret delaying effective treatment while trying home remedies. See Parent Experiences.

Flucloxacillin [relates] Parent Experiences

Connections

• Infected Eczema — first-line oral antibiotic, source: NICE NG190
• Staphylococcus aureus — targets beta-lactamase-producing staph, source: DermNet
• Impetigo — first-choice oral antibiotic for bullous/widespread impetigo, source: NICE NG153
• NICE NG153 — dosing and palatability advice, source: NICE 2020
• NICE NG190 — dosing for infected eczema, source: NICE 2021
• Clarithromycin — alternative for penicillin allergy or unpalatable suspension, source: NICE NG153/NG190
• Erythromycin — macrolide alternative in pregnancy, source: NICE NG153
• MRSA — not covered; microbiologist advice, source: NICE NG190
• Cochrane — no clear benefit of oral antibiotics vs placebo in infected eczema, source: George 2019
• Parent Experiences — parent reports (anecdotal), source: round-10 forum threads