Dicloxacillin

General

• Type: Penicillinase-resistant penicillin
• Dosage Forms: 250,500
• Common Trade Names:

Adult Dosing

Skin infections, staphylococcal

• 125-500mg PO q6h (1h before or 2h after meals)

Osteomyelitis

• 250-500mg PO q6h (1h before or 2h after meals)

Pediatric Dosing

Skin infections, staphylococcal

• <40 kg: 12.5-25mg/kg/day PO divided q6h
• >40kg: 125-500mg PO q6h

Osteomyelitis

• <40kg: 50-100mg/kg/day PO divided q6h
• >40kg: 250-500mg PO q6h

Special Populations

• Pregnancy risk: B (no evidence of risk)
• Lactation: safety unknown
• Renal Dosing
  • Adult: no adjustment
  • Pediatric: no adjustment
• Hepatic Dosing
  • Adult: not defined
  • Pediatric: not defined

Contraindications

• Allergy to class/drug
• caution in asthma
• caution in seizure disorder
• caution in renal impairment

Adverse Reactions

Serious

• anaphylaxis
• serum sickness-like reaction
• superinfection
• C-diff
• hemolytic anemia
• leukopenia
• agranulocytosis
• neutropenia
• thrombocytopenia
• esophagitis
• esophageal ulcer

Common

• nausea/vomiting
• diarrhea
• epigastric pain
• urticaria
• pruritus
• fever
• rash
• eosinophilia
• stomatitis
• black hairy tongue
• LFTs elevated

Pharmacology

• Half-life: 0.7h, if GFR < 10 then 1.8h
• Metabolism: liver partially
• Excretion: urine 50-70% (primarily unchanged), bile 10%
• Mechanism of Action: inhibits cell wall mucopeptide synthesis

Antibiotic Sensitivities

Group	Organism	Sensitivity
Gram Positive	Strep. Group A, B, C, G	S
	Strep. Pneumoniae	S
	Viridans strep	I
	Strep. anginosus gp	S
	Enterococcus faecalis	R
	Enterococcus faecium	R
	MSSA	S
	MRSA	R
	CA-MRSA	R
	Staph. Epidermidis	S
	C. jeikeium	R
	L. monocytogenes	R
Gram Negatives	N. gonorrhoeae	R
	N. meningitidis	R
	Moraxella catarrhalis	R
	H. influenzae	R
	E. coli	R
	Klebsiella sp	R
	E. coli/Klebsiella ESBL+	R
	E coli/Klebsiella KPC+	R
	Enterobacter sp, AmpC neg	R
	Enterobacter sp, AmpC pos	R
	Serratia sp	R
	Serratia marcescens	X1
	Salmonella sp	R
	Shigella sp	R
	Proteus mirabilis	R
	Proteus vulgaris	R
	Providencia sp.	R
	Morganella sp.	R
	Citrobacter freundii	R
	Citrobacter diversus	R
	Citrobacter sp.	R
	Aeromonas sp	R
	Acinetobacter sp.	R
	Pseudomonas aeruginosa	R
	Burkholderia cepacia	R
	Stenotrophomonas maltophilia	R
	Yersinia enterocolitica	R
	Francisella tularensis	X1
	Brucella sp.	X1
	Legionella sp.	R
	Pasteurella multocida	R
	Haemophilus ducreyi	X1
	Vibrio vulnificus	X1
Misc	Chlamydophila sp	R
	Mycoplasm pneumoniae	R
	Rickettsia sp	X1
	Mycobacterium avium	X1
Anaerobes	Actinomyces	R
	Bacteroides fragilis	R
	Prevotella melaninogenica	R
	Clostridium difficile	X1
	Clostridium (not difficile)	X1
	Fusobacterium necrophorum	X1
	Peptostreptococcus sp.	S

Key

• S susceptible/sensitive (usually)
• I intermediate (variably susceptible/resistant)
• R resistant (or not effective clinically)
• S+ synergistic with cell wall antibiotics
• U sensitive for UTI only (non systemic infection)
• X1 no data
• X2 active in vitro, but not used clinically
• X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
• X4 active in vitro, but not clinically effective for strep pneumonia

See Also

• Antibiotics (Main)