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Oxacillin

    DEA Class; Rx

    Common Brand Names; Bactocill

    • Penicillins, Penicillinase-Resistant

    Semisynthetic antistaphylococcal penicillin. Stable against penicillinase. Main use is for treating infections caused penicillinase-producing S. aureus, including bacteremia, skin and soft-tissue infections, respiratory tract infections, bone and joint infections, and UTIs.

    Indicated for the treatment of bacteremia due to methicillin-sensitive S. aureus.

    Indicated for Staphylococcal Infections

    Allergy to penicillins, cephalosporins, imipenem

    Solutions containing dextrose may be contraindicated in patients with known allergy to corn or corn products

    • Diarrhea
    • Nausea
    • Fever
    • Rash
    • Eosinophilia
    • Leukopenia
    • Neutropenia
    • Thrombocytopenia
    • Hepatotoxicity
    • Elevated AST
    • Acute interstitial nephritis
    • Serum sickness-like reaction

    Monitor neonates for renal impairment

    Serious and occasionally fatal hypersensitivity (anaphylactic shock with collapse) reactions have occurred in patients receiving penicillin; although anaphylaxis is more frequent following parenteral administration, it has occurred in patients receiving oral penicillins

    Whenever allergic reactions occur, penicillin should be withdrawn unless, in the opinion of the physician, the condition being treated is life-threatening and amenable only to penicillin therapy

    The use of antibiotics may result in overgrowth of nonsusceptible organisms; if new infections due to bacteria or fungi occur, the drug should be discontinued and appropriate measures taken

    When penicillin therapy is indicated, it should be initiated only after a comprehensive patient drug and allergy history obtained; if an allergic reaction occurs, the drug should be discontinued and the patient should receive supportive treatment, eg, artificial maintenance of ventilation, pressor amines, antihistamines, and corticosteroids

    Individuals with a history of penicillin hypersensitivity may also experience allergic reactions when treated with a cephalosporin

    Prescribing oxacillin Injection, USP in the absence of a proven or strongly suspected bacterial infection or a prophylactic indication is unlikely to provide benefit to the patient and increases the risk of the development of drug-resistant bacteria

    In the treatment of suspected staphylococcal infections, therapy should be changed to another active agent if culture tests fail to demonstrate presence of staphylococci

    Periodic assessment of organ system function including renal, hepatic, and hematopoietic should be made during prolonged therapy with oxacillin

    Blood cultures, white blood cells, and differential cell counts should be obtained prior to initiation of therapy and at least weekly during therapy with oxacillin

    Periodic urinalysis, blood urea nitrogen, and creatinine determinations should be performed during therapy with oxacillin and dosage alterations should be considered if these values become elevated; if any impairment of renal function is suspected or known to exist, a reduction in the total dosage should be considered and blood levels monitored to avoid possible neurotoxic reactions

    AST (SGOT) and ALT (SGPT) values should be obtained periodically during therapy to monitor for possible liver function abnormalities

    Reproduction studies performed in the mouse, rat, and rabbit revealed no evidence of impaired fertility or harm to the fetus due to penicillinase-resistant penicillins

    Penicillins are excreted in human milk; caution should be exercised when penicillins are administered to a nursing woman

    Adults

    6 g/day IV/IM is the FDA-approved dosage; however, 12 g/day IV/IM has been used off-label.

    Geriatric

    6 g/day IV/IM is the FDA-approved dosage; however, 12 g/day IV/IM has been used off-label.

    Adolescents

    weight 40 kg or more: 6 g/day IV/IM is the FDA-approved dosage; however, up to 200 mg/kg/day IV/IM (Max: 12 g/day) has been used off-label.
    weight less than 40 kg: 100 mg/kg/day IV/IM is the FDA-approved dosage; however, up to 200 mg/kg/day IV/IM has been used off-label.

    Children

    weight 40 kg or more: 6 g/day IV/IM is the FDA-approved dosage; however, up to 200 mg/kg/day IV/IM (Max: 12 g/day) has been used off-label.
    weight less than 40 kg: 100 mg/kg/day IV/IM is the FDA-approved dosage; however, up to 200 mg/kg/day IV/IM has been used off-label.

    Infants

    100 mg/kg/day IV/IM is the FDA-approved dosage; however, up to 200 mg/kg/day IV/IM has been used off-label.

    Neonates

    25 mg/kg/day IV/IM is FDA-approved for all neonates; however, the following doses have been used off-label:
    older than 7 days weighing more than 2 kg: up to 200 mg/kg/day IV/IM.
    older than 7 days weighing 2 kg or less: up to 150 mg/kg/day IV/IM.
    0 to 7 days weighing more than 2 kg: up to 150 mg/kg/day IV/IM.
    0 to 7 days weighing 2 kg or less: up to 100 mg/kg/day IV/IM.

    Oxacillin

    infusion solution

    • 1g/50mL
    • 2g/50mL

    powder for injection

    • 1g
    • 2g
    • 10g