(oks a SIL in)
- Methylphenyl Isoxazolyl Penicillin
- Oxacillin Sodium
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Bactocill in Dextrose: 1 g/50 mL (50 mL); 2 g/50 mL (50 mL)
Solution Reconstituted, Injection:
Generic: 1 g (1 ea); 2 g (1 ea); 10 g (1 ea)
Solution Reconstituted, Injection [preservative free]:
Generic: 1 g (1 ea); 2 g (1 ea); 10 g (1 ea)
Brand Names: U.S.
- Bactocill in Dextrose
- 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.
Into bile, amniotic, and pleural fluids; insignificant concentrations in CSF and aqueous humor
Urine and bile (unchanged drug)
Time to Peak
Serum: IM: 30 minutes; IV: 5 minutes
Neonates (PNA: 8 to 15 days): 1.6 hours
Infants and Children ≤2 years: 0.9 to 1.8 hours
Adults: 20 to 30 minutes; prolonged with renal impairment
~94% (mainly albumin)
Use: Labeled Indications
Staphylococcal infections: Treatment of infections caused by penicillinase-producing staphylococci that have demonstrated susceptibility to the drug; empiric therapy in suspected cases of resistant staphylococcal infections.
Limitations of use: Oxacillin should not be used in infections caused by organisms susceptible to penicillin G.
Off Label Uses
Catheter-related bloodstream infections
IDSA clinical practice guidelines suggest that oxacillin may be used as first-line therapy for the treatment of catheter-related bloodstream infections caused by methicillin-susceptible S. aureus or methicillin-susceptible, coagulase-negative Staphylococcus species.
Community-acquired pneumonia (children)
Following clinical guideline recommendations on the management of CAP reduces the incidence of morbidity and mortality related to pneumonia. A semisynthetic penicillin, such as IV oxacillin, is a preferred agent for treatment of children with CAP due to MSSA. Therapy should be initiated in the inpatient setting to potentially reduce morbidity and mortality.
Skin and soft tissue necrotizing infections
Based on the Infectious Diseases Society of America (IDSA) guidelines for the diagnosis and management of skin and soft tissue infections (SSTI), oxacillin is an effective and recommended treatment for necrotizing infections of the skin, fascia, and muscle due to methicillin-sensitive Staphylococcus aureus.
Surgical site infections
Based on the Infectious Diseases Society of America (IDSA) guidelines for the diagnosis and management of skin and soft tissue infections (SSTI), oxacillin is an effective and recommended option for treatment of surgical site infections occurring after surgery of the trunk or extremity (away from the axilla or perineum). Systemic antibacterials are not routinely indicated for surgical site infections, but may be beneficial (in conjunction with suture removal plus incision and drainage) in patients with significant systemic response (eg, temperature >38.5ºC, heart rate >110 beats per minute, erythema/induration extending >5 cm from incision, WBC >12,000/mm3).
Hypersensitivity (eg, anaphylaxis) to oxacillin, any penicillin, or any component of the formulation.
Note: May contain a significant amount of sodium; consult product specific labeling for amount.
Catheter-related bloodstream infections (off-label use): IV: 2 g every 4 hours (Mermel 2009)
Endocarditis, treatment: Methicillin-susceptible Staphylococcus aureus (MSSA) (off-label dose; AHA [Baddour 2015]): IV:
Native valve: 12 g/day in 4 or 6 divided doses (ie, 2 g every 4 hours or 3 g every 6 hours) for 6 weeks. Note: Dosing intended for complicated right-sided infective endocarditis (IE) or left-sided IE. For uncomplicated right-sided IE, 2 weeks of therapy may be adequate
Prosthetic valve: 12 g/day in 6 divided doses (ie, 2 g every 4 hours) for at least 6 weeks (use with rifampin for entire course and gentamicin for first 2 weeks)
Mild to moderate infections: IM, IV: 250 to 500 mg every 4 to 6 hours
Osteomyelitis, native vertebral (off-label dose): Staphylococcus (oxacillin-susceptible): IV: 1.5 to 2 g every 4 to 6 hours or via continuous infusion for 6 weeks (IDSA [Berbari 2015])
Prosthetic joint infection: IV: 2 g every 4 hours with rifampin
Severe infections: IM, IV: 1 g every 4 to 6 hours
Staphylococcus aureus, methicillin-susceptible infections, including brain abscess, bursitis, erysipelas, mastitis, mastoiditis, osteomyelitis, perinephric abscess, pneumonia, pyomyositis, scalded skin syndrome, toxic shock syndrome: IV: 2 g every 4 hours
Skin and soft tissue infections (IDSA [Stevens 2014]): IV:
Due to methicillin-susceptible Staphylococcus aureus (MSSA): 1 to 2 g every 4 hours for 7 to 14 days
Necrotizing infection due to MSSA (off-label use): 1 to 2 g every 4 hours; continue until further debridement is not necessary, patient has clinically improved, and patient is afebrile for 48 to 72 hours
Surgical site infections (trunk or extremity [away from axilla or perineum]) (off-label use): IV: 2 g every 6 hours (IDSA [Stevens 2014])
Refer to adult dosing. Note: May contain a significant amount of sodium; consult product specific labeling for amount. The geriatric population may respond with a blunted natriuresis to salt loading. This may be clinically important in diseases such as congestive heart failure.
Note: May contain a significant amount of sodium; consult product specific labeling for amount.
General dosing, susceptible infection:
Mild to moderate infections:
Infants and Children <40 kg: IM, IV: 50 mg/kg/day in divided doses every 6 hours
Children ≥40 kg and Adolescents: IM, IV: 250 to 500 mg every 4 to 6 hours
Alternate dosing: Infants, Children, and Adolescents: IM, IV: 100 to 150 mg/kg/day in divided doses every 6 hours; maximum daily dose: 4,000 mg/day (Red Book [AAP 2015])
Infants and Children <40 kg: IM, IV: 100 mg/kg/day in divided doses every 4 to 6 hours
Children ≥40 kg and Adolescents: IM, IV: 1,000 mg every 4 to 6 hours
Alternate dosing: Infants, Children, and Adolescents: IM, IV: 150 to 200 mg/kg/day in divided doses every 4 to 6 hours; maximum daily dose: 12 g/day (Red Book [AAP 2015]); however, manufacturer labeling suggests a maximum daily dose of 6 g/day in adults when treating severe infection
Catheter-related bloodstream infections: Infants and Children: IV: 150 to 200 mg/kg/day divided every 4 to 6 hours (Mermel 2009)
Community-acquired pneumonia (CAP), moderate to severe infection, S. aureus (methicillin-susceptible) (preferred): Infants >3 months, Children and Adolescents: IV: 150 to 200 mg/kg/day divided every 6 to 8 hours (IDSA/PIDS [Bradley 2011])
Endocarditis, treatment (off-label): Children and Adolescents: IV: 200 mg/kg/day in divided doses every 4 to 6 hours; maximum daily dose: 12 g/day; treat for at least 4 weeks; longer duration may be necessary; may use in combination with gentamicin for some resistant organisms (AHA [Baltimore 2015])
Meningitis: Infants, Children, and Adolescents: IV: 200 mg/kg/day in divided doses every 6 hours; maximum daily dose: 12 g/day (Tunkel 2004)
Skin and soft tissue infections (IDSA [Stevens 2014]): Infants, Children and Adolescents:
Due to methicillin-susceptible Staphylococcus aureus (MSSA): IV: 100 to 150 mg/kg/day in divided doses every 6 hours for 7 to 14 days; maximum daily dose: 12 g/day
Necrotizing infection due to MSSA (off-label use): IV: 200 mg/kg/day in divided doses every 6 hours; continue until further debridement is not necessary, patient has clinically improved, and patient is afebrile for 48 to 72 hours. Maximum daily dose: 12 g/day
Dosing: Renal Impairment
There are no dosage adjustments provided in the manufacturer's labeling; however, manufacturer suggests considering a reduction in total dosage if renal impairment is known or suspected.
Dosing: Hepatic Impairment
There are no dosage adjustments provided in the manufacturer’s labeling.
IM: After reconstitution, vials will contain oxacillin 250 mg/1.5 mL. Refer to manufacturer's product labeling for more information.
1 gram vial: Add sterile water for injection or NS 10 mL; shake well.
2 gram vial: Add sterile water for injection or NS 20 mL; shake well.
10 gram vial: Add sterile water for injection or NS 93 mL; shake well. The resulting solution will contain oxacillin 100 mg/mL and requires further dilution in compatible IV solution (eg, D5W, NS) prior to administration.
Administer IV or IM around-the-clock to promote less variation in peak and trough serum levels. Administer IVP over 10 minutes. Administer IVPB over 30 minutes.
Some products may contain sodium.
Premixed infusions: Store in a freezer at -20°C (4°F). Thaw at room temperature or under refrigeration only. Thawed bags are stable for 21 days under refrigeration or 48 hours at room temperature. Do not refreeze.
Vials: Store intact vials at 20°C to 25°C (68°F to 77°F); refer to manufacturer’s labeling for specific storage instructions after dilution (varies by concentration and diluent).
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): Penicillins may enhance the anticoagulant effect of Vitamin K Antagonists. Monitor therapy
May interfere with urinary glucose tests using cupric sulfate (Benedict's solution, Clinitest®); may inactivate aminoglycosides in vitro; false-positive urinary and serum proteins
Frequency not defined.
Dermatologic: Skin rash
Gastrointestinal: Diarrhea, nausea, vomiting
Hematologic & oncologic: Agranulocytosis, eosinophilia, leukopenia, neutropenia, thrombocytopenia
Hepatic: Hepatotoxicity, increased serum AST
Immunologic: Serum sickness-like reaction
Renal: Acute interstitial nephritis
Concerns related to adverse effects:
• Anaphylactic/hypersensitivity reactions: Serious and occasionally fatal hypersensitivity (anaphylactic) reactions have been reported in patients on penicillin therapy, especially with a history of beta-lactam hypersensitivity, history of sensitivity to multiple allergens, or previous IgE-mediated reactions (eg, anaphylaxis, angioedema, urticaria). Use with caution in patients with histories of significant allergies and/or asthma; discontinue treatment and institute appropriate therapy if an allergic reaction occurs
• Hepatitis: Acute hepatitis and reversible elevations of serum transaminases have been reported sometimes accompanied by rash and leukopenia; onset after 2 to 3 weeks of therapy; monitor periodically throughout therapy (Dahlgren 1997; Faden 2009; Maraqa 2002).
• 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.
• Renal impairment: Use with caution; dosage adjustment recommended.
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.
• Elderly: May contain a significant amount of sodium; consult product specific labeling for amount. The elderly population may respond with a blunted natriuresis to salt loading. This may be clinically important in diseases such as congestive heart failure.
• Neonates: Use with caution in neonates; elimination of drug is decreased; dosage adjustment is needed.
Observe for signs and symptoms of anaphylaxis during first dose; monitor periodic CBC, urinalysis, BUN, serum creatinine, AST and ALT
Adverse events have not been observed in animal reproduction studies. Oxacillin is distributed into the amniotic fluid and is detected in cord blood. Maternal use of penicillins has generally not resulted in an increased risk of adverse fetal effects.
• 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 nausea, vomiting, tongue discoloration, or diarrhea. Have patient report immediately to prescriber signs of liver problems (dark urine, fatigue, lack of appetite, nausea, abdominal pain, light-colored stools, vomiting, or jaundice), severe dizziness, passing out, muscle pain, joint pain, mouth irritation, hematuria, severe loss of strength and energy, dark urine, change in amount of urine passed, urinary retention, bruising, bleeding, severe abdominal pain, 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.
Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for health care professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience, and judgment in diagnosing, treating, and advising patients.
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- Drug class: penicillinase resistant penicillins
Other brands: Bactocill