Oxacillin

Indications

Oxacillin is used for: Staphylococcal Infections, Severe infections

Adult Dose

Staphylococcal Infections Mild to moderate infections: 250-500 mg IV/IM q4-6hr Severe infections: 1 g IV/IM q4-6hr Acute/chronic osteomyelitis/staphylococci infections: 1.5-2 g IV q4-6hr

Child Dose

Susceptible Staph Infections in Infants & Children Mild to moderate infections: 100-200 mg/kg/day IV/IM divided q6hr Severe infections: 150-200 mg/kg/day IV/IM divided q6hr Maximum 4g/day for mild to moderate infections Maximum 12g/day for severe infections Susceptible Staph Infections in Neonates (<7 days old, <2 kg) OR (>7 days old, <1.2 kg): 50 mg/kg/day divided q12hr IV/IM (<7 days old, >2 kg) OR (>7 days old, 1.2-2 kg): 75 mg/kg/day divided q8hr IV/IM >7 days old, >2 kg: 100 mg/kg/day divided q6hr IV/IM

Renal Dose

Renal Infection CrCl < 10 mL/min: May consider adjusting to the lower range of the usually recommended dose depending on severity of infection

Administration

IV/IM Preparation IM Injection For IM injection, reconstitute by adding 5.7 or 11.4 mL of SWI to a vial containing 1 or 2 g of oxacillin, respectively, to provide solutions containing 167 mg of oxacillin per mL (250 mg/1.5 mL) Shake vials well IV Injection For direct injection, prepare a solution containing approximately 100 mg/mL by adding 10 or 20 mL SWI, ½NS or NS to vials containing 1 or 2 g of oxacillin, respectively Intermittent or Continuous IV Infusion For intermittent IV infusion, reconstitute vials containing 1 or 2 g as for direct IV injection & further dilute with a compatible IV solution to a concentration of 0.5-40 mg/mL Alternatively, reconstitute ADD-Vantage vials containing 1 or 2 g according to the mfr's directions IV/IM Administration Administer by IM injection or slow IV injection or infusion IM: deep into a large muscle (eg, gluteus maximus) & care should be taken to avoid sciatic nerve injury IV Injection: slowly over about 10 min Intermittent or Continuous IV Infusion: injections should not be used in series connections with other plastic containers: could result in air embolism from residual air being drawn from primary container before administration of fluid from secondary container is complete

Contra Indications

Allergy to penicillins, cephalosporins, imipenem Solutions containing dextrose may be contraindicated in patients with known allergy to corn or corn products

Precautions

Evaluate renal, hepatic, hematologic systems periodically during prolonged treatment Monitor neonates for renal impairment Monitor organ systems/serum concentrations of drug in neonates Prolonged treatment may result in bacterial or fungal superinfection Clostridium difficile associated diarrhea (CDAD) must be considered in all patients who present with diarrhea following antibiotic; CDAD has been reported to occur over two months after the administration of antibacterial agents; careful medical history is necessary; if CDAD suspected or confirmed, ongoing antibiotic use not directed against C. difficile may need to be discontinued; appropriate fluid and electrolyte management, protein supplementation, antibiotic treatment of C. difficile, and surgical evaluation should be instituted as indicated

Pregnancy-Lactation

Pregnancy Category: B Lactation: excreted in breast milk; use caution

Interactions

Adverse Effects

Side effects of Oxacillin : 1-10% Diarrhea Nausea Fever Rash <1% Eosinophilia Leukopenia Neutropenia Thrombocytopenia Hepatotoxicity Elevated AST Acute interstitial nephritis Serum sickness-like reaction

Mechanism of Action

Bactericidal antibiotic that inhibits cell wall synthesis by binding to one or more of the penicillin binding proteins. Used in the treatment of infections caused by penicillinase-producing staphylococci. May be used to initiate therapy when a staphylococcal infection is suspected.