From the Research
In New Zealand, the combination of probenecid and flucloxacillin is recommended for serious staphylococcal infections, with the most recent guidelines suggesting shorter antibiotic treatment courses and the use of new antimicrobials 1. The standard adult dosing is flucloxacillin 2g IV every 4-6 hours with probenecid 500mg orally twice daily. For outpatient management, flucloxacillin can be given as 1-2g IV once daily with probenecid 1g orally once daily. Probenecid works by inhibiting the renal tubular secretion of flucloxacillin, thereby increasing its serum concentration and prolonging its half-life. This combination is particularly useful for treating deep-seated infections like osteomyelitis, septic arthritis, or endocarditis where higher antibiotic concentrations are beneficial. Some key points to consider when using this combination include:
- Probenecid should be used cautiously in patients with renal impairment, and is contraindicated in those with a history of kidney stones or gout.
- Common side effects include nausea, headache, and dizziness.
- Patients should be advised to maintain adequate hydration while taking probenecid to reduce the risk of crystalluria.
- The duration of therapy depends on the specific infection being treated, typically ranging from 2-6 weeks for serious infections, as supported by recent guidelines 1. It's also important to note that the management of skin and soft tissue infections should rely on a collaborative group with experience in this disease, and that surgical indication and its value are evident in many patients 1. In terms of specific evidence, a study from 2022 highlights the need to refine the appropriate drug's decision-making, with a focus on using new antimicrobials and shorter antibiotic treatment courses 1. Overall, the combination of probenecid and flucloxacillin remains a viable option for the treatment of serious staphylococcal infections in New Zealand, with careful consideration of patient factors and adherence to recent guidelines.