# Musculoskeletal system infection - Category: infectious - Review status: reviewed (every claim checked against a document named on this page) - Sources: Egyptian National Drug Formulary - Antimicrobial 2023, flucloxacillin monograph (antimicrobial-2023.pdf page index 360, printed p351) · Egyptian National Drug Formulary - antimicrobial-2023.pdf, Clindamycin monograph (chapter PDF p287) · Egyptian National Drug Formulary - antimicrobial-2023.pdf, Flucloxacillin monograph (chapter PDF p361) · Antimicrobial recommendations and dosages for secondary bacterial skin infection. Annex 3, in: Clinical management and infection prevention and control for mpox: living guideline [Internet]. Geneva: World Health Organization; 2025 May-. NBK616035. - Verified date: 2026-08 ## Verified against - Egyptian National Drug Formulary - Antimicrobial 2023, flucloxacillin monograph (antimicrobial-2023.pdf page index 360, printed p351) - Egyptian National Drug Formulary - antimicrobial-2023.pdf, Clindamycin monograph (chapter PDF p287) - Antimicrobial recommendations and dosages for secondary bacterial skin infection. Annex 3, in: Clinical management and infection prevention and control for mpox: living guideline [Internet]. Geneva: World Health Organization; 2025 May-. NBK616035. ## Treatment metadata - Flucloxacillin — oral.solid - Clindamycin — oral.solid ## Complete treatment card ```text MUSCULOSKELETAL SYSTEM INFECTION Sources: Egyptian National Drug Formulary - Antimicrobial 2023, flucloxacillin monograph (antimicrobial-2023.pdf page index 360, printed p351) · Egyptian National Drug Formulary - antimicrobial-2023.pdf, Clindamycin monograph (chapter PDF p287) · Egyptian National Drug Formulary - antimicrobial-2023.pdf, Flucloxacillin monograph (chapter PDF p361) · Antimicrobial recommendations and dosages for secondary bacterial skin infection. Annex 3, in: Clinical management and infection prevention and control for mpox: living guideline [Internet]. Geneva: World Health Organization; 2025 May-. NBK616035. Review status: REVIEWED against 2 sources listed above (2026-08) 1. FLUCLOXACILLIN [1st line] Adult 250 mg by mouth four times daily on an empty stomach; may be doubled to 500 mg four times daily in severe infection. For osteomyelitis the formulary allows up to 8 g daily in 3 or 4 divided doses - it does not state the route for that, so treat it as specialist-directed, usually inpatient, dosing. - Not specified in the formulary for this indication Peds Oral, for staphylococcal skin, ear and chest infection (BNFC bands quoted by the formulary): 1 month to 1 year, 62.5 to 125 mg; 2 to 9 years, 125 to 250 mg; 10 years and older, 250 to 500 mg - all four times daily. These are fixed mg bands by age, not weight-calculated. Bone and joint infection is dosed differently and intravenously (50 mg/kg, maximum 2 g, every 6 hours from 1 month of age) and is specialist/inpatient care - do not calculate it on this oral row. Source Egyptian National Drug Formulary - Antimicrobial 2023, flucloxacillin monograph (antimicrobial-2023.pdf page index 360, printed p351) Why Flucloxacillin is the first-choice oral antibiotic for staphylococcal soft-tissue and musculoskeletal infections that a GP can manage without hospital referral. Caution In severe renal impairment a dose reduction may be necessary; in children with creatinine clearance under 10 mL/min give the normal dose no more often than every 8 hours. Take on an empty stomach, 30 to 60 minutes before food or at least 2 hours after. Hepatitis and cholestatic jaundice can occur and may be delayed up to 2 months after stopping; risk is greater in older patients and in courses longer than 2 weeks. Signs of joint involvement (possible septic arthritis), rapidly spreading infection, systemic fever, diabetic foot involvement, immunocompromise. Do not use if there is true penicillin allergy - use clindamycin or another alternative instead. Signs of joint involvement, rapidly spreading infection, systemic fever, or diabetic foot involvement need urgent referral rather than oral outpatient treatment alone. Higher IV doses are used for osteomyelitis and severe infection - refer for IV therapy rather than treating deep bone/joint infection with the standard oral dose. Reduce dose in severe renal impairment. Egypt FLUMOCIN 250MG 12CAPS. UP PHARMA 6.20 EGP (0.52/unit) -> ! also contains amoxicillin AMOFLUX 125/125MG 12 CAPS. RAMEDA > DELT... 8.25 EGP (0.69/unit) -> ! also contains amoxicillin FLUCAMOX 250MG 12CAPS. SEDICO 8.25 EGP (0.69/unit) -> ! also contains amoxicillin FLUMOCIN 500MG 8 CAPS. UP PHARMA 6.00 EGP (0.75/unit) -> ! also contains amoxicillin CURAFLUX 125/125 MG 12 CAPS. RAMEDA > PIONEER 12.50 EGP (1.04/unit) -> ! also contains amoxicillin AMOFLUX 250/250MG 16 CAPS. RAMEDA > PIONEER 18.00 EGP (1.12/unit) -> ! also contains amoxicillin HI-FLUCIL 250/250MG 16 CAPS. CID 20.00 EGP (1.25/unit) -> ! also contains amoxicillin AMPIFLUX 500 MG 12 CAPS. PHARCO 16.00 EGP (1.33/unit) -> ! also contains ampicillin 2. CLINDAMYCIN [2nd line] Adult 150-300 mg by mouth every 6 hours. - As directed by response; typically at least 5-7 days, longer for bone/joint infection under specialist guidance. Peds Paediatric dosing is specialist-set and is not reproduced here (the formulary gives detailed weight-based paediatric regimens). Source Egyptian National Drug Formulary - antimicrobial-2023.pdf, Clindamycin monograph (chapter PDF p287) Why Clindamycin is a reasonable alternative to flucloxacillin for musculoskeletal/soft- tissue staphylococcal infection, particularly in penicillin allergy or when anaerobic organisms are suspected. Caution There is a risk of Clostridioides difficile-associated diarrhoea - stop and seek advice if severe or persistent diarrhoea develops. Use as the alternative when flucloxacillin cannot be used (e.g. penicillin allergy) or when anaerobic cover is also needed. Deep bone/joint infection (osteomyelitis, septic arthritis) needs a higher-severity dosing tier and urgent specialist referral rather than routine outpatient treatment. Egypt ADCOCLINDACE 150 MG 16 CAPS. ARAB DRUG COM... 14.50 EGP (0.91/unit) ALFACLINDAMYCIN 150 MG 10 CAPS. ATCO PHARMA >... 14.50 EGP (1.45/unit) ADCOCLINDACE 300 MG 16 CAPS. ARAB DRUG COM... 24.00 EGP (1.50/unit) CLINACYN 300MG 16 CAPS. SIGMA > EGYPT... 31.50 EGP (1.97/unit) MEPACLIND 150MG 16 CAPS. MEPACO 48.00 EGP (3.00/unit) MEPACLIND 300MG 8 CAPS. MEPACO 38.00 EGP (4.75/unit) ALFACLINDAMYCIN 300 MG 10 CAPS. ATCO PHARMA >... 69.00 EGP (6.90/unit) DALACIN C 300MG 10 CAPS. PFIZER 114.00 EGP (11.40/unit) KLENDABIOTICAM 1 % TOP. SOLUTION PANAX PHARMA 8.50 EGP -> ? strength differs, ? different route - not oral solid ADCOCLINDACE 10MG/ML TOP. SOL. ARAB DRUG COM... 12.00 EGP -> ? strength differs, ? different route - not oral solid Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)