Oxacillin

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General

  • Type: Anti-Staphylococcal Penicillin
  • Dosage Forms: IM; IV
  • Common Trade Names: Bactocill

Adult Dosing

General

  • Mild-to-moderate infection
    • 250-500mg IM/IV q4-6 hours
  • Severe infection
    • 1g IM/IV q4-6 hours

Endocarditis

Prosthetic Joint Infection

MSSA

Pediatric Dosing

General

  • Mild-to-moderate
    • 50mg/kg/day IM/IV divided q6 hours
    • First Dose: 12.5mg/kg IM/IV x 1
    • Max: 4 g/day
  • Severe
    • 100mg/kg/day IM/IV divided q4-6 hours
    • First Dose: 16.6-25mg/kg IM/IV x 1
    • Max: 12 g/day

Community-Acquired Pneumonia (>3 Months)[1]

  • 150-200mg/kg/day divided q6-8 hours
  • First Dose: 37.5-66.6mg/kg IV x 1
  • For MSSA

Special Populations

  • Pregnancy Rating: B
  • Lactation: Use caution
  • Renal Dosing
    • Adult: No adjustment
    • Pediatric:
      • CrCl <10: Use lower end of dosing range
  • Hepatic Dosing
    • Adult: Not defined
    • Pediatric: Not defined

Contraindications

  • Allergy to class/drug
  • Caution:
    • Non-anaphylactic hypersensitivity to beta-lactams
    • Hypersensitivity to corn
    • Asthma
    • Recent abx-associated colitis
    • Renal impairment
    • Sodium restriction
    • Seizure disorder

Adverse Reactions

Serious

Common

Pharmacology

  • Half-life: 20-60 minutes (prolonged in neonates and renal impairment)
  • Metabolism: Liver 45%; active metabolite
  • Excretion: Urine (55-60% unchanged), Bile 10%
  • Mechanism of Action: Bactericidal; inhibits cell wall mucopeptide synthesis

Antibiotic Sensitivities[2]

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

References

  1. IDSA/PIDS, 2011
  2. Sanford Guide to Antimicrobial Therapy 2014