Medically reviewed on March 25, 2018
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- Dicloxacillin Sodium
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Generic: 250 mg, 500 mg
- Antibiotic, Penicillin
Inhibits bacterial cell wall synthesis by binding to one or more of the penicillin-binding proteins (PBPs) which in turn inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell walls, thus inhibiting cell wall biosynthesis. Bacteria eventually lyse due to ongoing activity of cell wall autolytic enzymes (autolysins and murein hydrolases) while cell wall assembly is arrested.
Rapid and incomplete; reduced by food
Vd: 5.99 L; increased in patients with ESRD on IHD (Nauta 1976); CSF penetration is low
Feces; urine (as unchanged drug)
CF patients: More rapid excretion than healthy patients (Jusko 1975)
Time to Peak
Serum: 1 to 1.5 hours
~0.7 hours; prolonged with renal impairment (Nauta 1976)
95% to 99%
Use: Labeled Indications
Staphylococcal infections: Treatment of infections caused by penicillinase-producing staphylococci.
Off Label Uses
Bite wounds (animal)
Based on the Infectious Diseases Society of America (IDSA) guidelines for the diagnosis and management of skin and soft tissue infections (SSTI), dicloxacillin, in combination with penicillin, is an effective and recommended option for treatment of animal bites.
Based on the Infectious Diseases Society of America (IDSA) guidelines for the diagnosis and management of skin and soft tissue infections (SSTI), dicloxacillin is an effective and recommended agent for treatment of impetigo [IDSA [Stevens 2014].
Hypersensitivity to dicloxacillin, other penicillins, or any component of the formulation
Staphylococcal infections: Oral: 125 to 250 mg every 6 hours
Bite wounds (animal) (off-label use): Oral: 500 mg 4 times daily; in combination with penicillin (IDSA [Stevens 2014])
Impetigo (off-label use): Oral: 250 mg 4 times daily for 7 days, depending on response (IDSA [Stevens 2014])
Prosthetic joint infection: Chronic suppression therapy: Staphylococci (oxacillin-susceptible) (off-label dose): Oral: 500 mg every 6 to 8 hours (Osmon 2013)
Skin and soft tissue infection due to MSSA (off-label dose): Oral: 500 mg every 6 hours for 7 to 14 days (IDSA [Stevens 2014])
Refer to adult dosing.
General dosing, susceptible infection (Bradley 2016; Red Book [AAP 2015]): Infants, Children, and Adolescents:
Mild to moderate infection: Oral: 12 to 25 mg/kg/day divided every 6 hours; maximum dose: 250 mg/dose
Severe infection (step-down therapy of bone and joint infection): Oral: 100 mg/kg/day divided every 6 hours; maximum dose: 500 mg/dose
Skin and soft tissue infection, methicillin-susceptible Staphylococcus aureus (MSSA) (off-label dose): Infants, Children, and Adolescents: 25 to 50 mg/kg/day divided every 6 hours; maximum dose: 500 mg/dose (IDSA [Stevens 2014])
Dosing: Renal Impairment
There are no specific dosage adjustments provided in the manufacturer's labeling; a reduction in total dosage should be considered in renal impairment.
Hemodialysis: Not dialyzable; supplemental dose is not necessary (Aronoff 2007).
Peritoneal dialysis effects: Supplemental dose is not necessary (Aronoff 2007).
Dosing: Hepatic Impairment
There are no dosage adjustments provided in the manufacturer's labeling.
Oral: Administer 1 hour before or 2 hours after meals with at least 120 mL of water. Administer around-the-clock to promote less variation in peak and trough serum levels. Should not be administered in the supine position or immediately before going to bed.
Store at 20°C to 25°C (68°F to 77°F).
Acemetacin: May increase the serum concentration of Penicillins. Monitor therapy
BCG (Intravesical): Antibiotics may diminish the therapeutic effect of BCG (Intravesical). Avoid combination
BCG Vaccine (Immunization): Antibiotics may diminish the therapeutic effect of BCG Vaccine (Immunization). Monitor therapy
Cholera Vaccine: Antibiotics may diminish the therapeutic effect of Cholera Vaccine. Avoid combination
Lactobacillus and Estriol: Antibiotics may diminish the therapeutic effect of Lactobacillus and Estriol. Monitor therapy
Methotrexate: Penicillins may increase the serum concentration of Methotrexate. Monitor therapy
Mycophenolate: Penicillins may decrease serum concentrations of the active metabolite(s) of Mycophenolate. This effect appears to be the result of impaired enterohepatic recirculation. Monitor therapy
Probenecid: May increase the serum concentration of Penicillins. Management: Avoid the routine use of penicillins and probenecid, but this combination may be used advantageously in select cases with careful monitoring. Monitor for toxic effects of penicillins if probenecid is initiated or the dose is increased. Consider therapy modification
Sodium Picosulfate: Antibiotics may diminish the therapeutic effect of Sodium Picosulfate. Management: Consider using an alternative product for bowel cleansing prior to a colonoscopy in patients who have recently used or are concurrently using an antibiotic. Consider therapy modification
Tetracyclines: May diminish the therapeutic effect of Penicillins. Consider therapy modification
Typhoid Vaccine: Antibiotics may diminish the therapeutic effect of Typhoid Vaccine. Only the live attenuated Ty21a strain is affected. Management: Vaccination with live attenuated typhoid vaccine (Ty21a) should be avoided in patients being treated with systemic antibacterial agents. Use of this vaccine should be postponed until at least 3 days after cessation of antibacterial agents. Consider therapy modification
Vitamin K Antagonists (eg, warfarin): Dicloxacillin may diminish the anticoagulant effect of Vitamin K Antagonists. Monitor therapy
False-positive urine and serum proteins; false-positive in uric acid, urinary steroids; may interfere with urinary glucose tests using cupric sulfate (Benedict's solution, Clinitest®); may inactivate aminoglycosides in vitro
Frequency not defined.
1% to 10%: Gastrointestinal: Abdominal pain diarrhea, nausea
<1%, postmarketing, and/or case reports: Agranulocytosis, anemia, eosinophilia, fever, hematuria, hemolytic anemia, hepatotoxicity, hypersensitivity reaction, increased blood urea nitrogen, increased liver enzymes (transient), increased serum creatinine, interstitial nephritis, leukopenia, neutropenia, prolonged prothrombin time, pseudomembranous colitis, seizure (with extremely high doses and/or renal failure), serum sickness-like reaction, skin rash (maculopapular rash to exfoliative dermatitis), thrombocytopenia, vaginitis, vomiting
Concerns related to adverse effects:
• Hypersensitivity reactions: Serious and occasionally fatal hypersensitivity (anaphylactic shock with collapse) reactions have been reported in patients on penicillin therapy. Initiate therapy only after a comprehensive drug and allergy history; use with caution in patients with a history of significant allergies and/or asthma. Discontinue use and institute appropriate therapy if a hypersensitivity reaction occurs.
• Superinfection: Prolonged use may result in fungal or bacterial superinfection, including C. difficile-associated diarrhea (CDAD) and pseudomembranous colitis; CDAD has been observed >2 months postantibiotic treatment.
Concurrent drug therapy issues:
• Drug-drug interactions: Potentially significant interactions may exist, requiring dose or frequency adjustment, additional monitoring, and/or selection of alternative therapy. Consult drug interactions database for more detailed information.
• Neonates: Use with caution in neonates; elimination of drug is slow.
Baseline and periodic CBC with differential; periodic BUN, serum creatinine, AST and ALT (especially with prolonged therapy); prothrombin time if patient concurrently on warfarin; signs of anaphylaxis during first dose
Pregnancy Risk Factor
Adverse events have not been observed in animal reproduction studies. Dicloxacillin crosses the placenta (Depp 1970). Maternal use of penicillins has generally not resulted in an increased risk of birth defects.
• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)
• Patient may experience diarrhea. Have patient report immediately to prescriber shortness of breath, wheezing, severe nausea, severe vomiting, mouth irritation, tongue discoloration, bruising, bleeding, pharyngitis, joint pain, joint edema, or signs of Clostridium difficile (C. diff)-associated diarrhea (abdominal pain or cramps, severe diarrhea or watery stools, or bloody stools) (HCAHPS).
• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.
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- Drug class: penicillinase resistant penicillins