Dicloxacillin Sodium

Pronunciation: DIE-klox-uh-SILL-in SO-dee-uhm
Class: Penicillinase-resistant penicillin

Trade Names

Dicloxacillin Sodium
- Capsules 250 mg
- Capsules 500 mg

Pharmacology

Inhibits bacterial cell wall mucopeptide synthesis.

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Pharmacokinetics

Absorption

Rapid and incomplete absorption. T _max is 1 to 1.5 h. C _max is 10 to 17 mcg/mL. Food delays absorption; take on empty stomach.

Distribution

Approximately 98% protein bound, mainly to albumin. Excreted in breast milk and crosses the placenta. Low CSF penetration.

Elimination

Rapidly eliminated, primarily as unchanged drug in the urine. Nonrenal elimination includes hepatic inactivation and excretion in bile. t _½ approximately 0.7 h.

Indications and Usage

Treatment of infections caused by penicillinase-producing staphylococcal infection; initial therapy of suspected staphylococcal infection.

Contraindications

Hypersensitivity to penicillins.

Dosage and Administration

PO 125 to 250 mg every 6 h.

PO 12.5 to 25 mg/kg/day divided in equal doses every 6 h.

General Advice

• Capsules can be opened and contents mixed with small amount of food or fluid, but patient may experience bad taste.
• Give with full glass of water, not juice or carbonated beverage.

Drug Interactions

May reduce efficacy of oral contraceptives.

Antibacterial action may be reduced.

May impair bactericidal effects of dicloxacillin.

Laboratory Test Interactions

May cause false-positive urine glucose test results with Benedict solution, Fehling solution, or Clinitest tablets but not with enzyme-based tests (eg, Clinistix , Tes-tape ); false-positive direct Coombs test results in certain patient groups; false-positive protein reactions with sulfosalicylic acid and boiling test, acetic acid test, biuret reaction and nitric acid test but not with bromphenol blue test ( Multistix ).

Adverse Reactions

CNS

Dizziness; fatigue; insomnia; reversible hyperactivity; seizures.

Dermatologic

Urticaria; dermatitis; vesicular eruptions; erythema multiforme; rashes.

EENT

Laryngospasm; laryngeal edema; itchy eyes.

GI

Glossitis; stomatitis; gastritis; sore mouth or tongue; dry mouth; furry tongue; “black hairy” tongue; abnormal taste sensation; anorexia; nausea; vomiting; abdominal pain or cramps; diarrhea or bloody diarrhea; rectal bleeding; flatulence; enterocolitis; pseudomembranous colitis.

Genitourinary

Interstitial nephritis (eg, oliguria, proteinuria, hematuria, hyaline casts, pyuria); nephropathy.

Hematologic

Anemias; thrombocytopenia; eosinophilia; leukopenia; granulocytopenia; neutropenia; bone marrow depression; agranulocytosis; reduced hemoglobin or hematocrit; prolonged bleeding and prothrombin time; altered lymphocyte count; increased monocytes, basophils, platelets.

Hepatic

Transient hepatitis; cholestatic jaundice.

Metabolic

Elevated serum alkaline phosphatase and hypernatremia; reduced serum potassium, albumin, total proteins and uric acid.

Miscellaneous

Hypersensitivity reactions that may lead to death; vaginitis; hyperthermia.

Precautions

Pregnancy

Category B .

Lactation

Excreted in breast milk.

Hypersensitivity

Reactions range from mild to life-threatening. Administer cautiously to cephalosporin-sensitive patients because of possible cross-reactivity.

Superinfection

May result in bacterial or fungal overgrowth of nonsusceptible organisms.

Pseudomembranous colitis

Consider possibility in patients with diarrhea.

Patient Information

• Instruct patient to take antibiotic on empty stomach before (30 min to 1 h) meals or after (2 h) meals with full glass of water.
• Explain that doses should be evenly spaced throughout day and night to maintain adequate drug levels.
• Teach patient signs of sensitivity reaction and appropriate steps to take if occurring.
• Tell patient to discard any liquid solution after 7 days when stored at room temperature or after 14 days of refrigeration.
• Instruct patient to shake bottle before measuring pediatric suspension and to use a medication cup or other calibrated device for accurate dosing.
• Teach patient signs of superinfection, which can occur with any antibiotic (eg, black, furry tongue, vaginal itching) and tell patient to notify health care provider if any occur.
• Instruct patient never to share antibiotic prescriptions with others.
• Advise patient to follow complete course of therapy, even if feeling better.

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