DICLOXACILLIN SODIUM
| DICLOXACILLIN SODIUM (dye-klox-a-sill'in) Dycill, Dynapen, Pathocil Classifications: antibiotic, penicillin; Therapeutic: penicillin antibiotic Prototype: Penicillin G potassium Pregnancy Category: B |
Availability
125 mg, 250 mg, 500 mg capsules; 62.5 mg/5 mL suspension
Action
Semisynthetic, acid-stable, penicillinase-resistant penicillin. It inhibits the final stage of bacterial cell wall synthesis by preferentially binding to specific penicillin-binding proteins (PBPs) that are located inside the bacterial cell wall; this leads to cell death.
Therapeutic Effect
Reportedly the most active of these penicillins (cloxacillin, oxacillin) against penicillinase-producing Staphylococci. Generally ineffective against methicillin-resistant Staphylococci and gram-negative bacteria.
Uses
Primarily in systemic infections caused by penicillinase-producing Staphylococci and penicillin-resistant Staphylococci.
Contraindications
Hypersensitivity to penicillins.
Cautious Use
History of or suspected atopy or allergy (asthma, eczema, hives, hay fever); history of hypersensitivity to cephalosporins or carbapenem; GI disease, colitis; lactation; renal or hepatic impairment; pregnancy (category B).
Route & Dosage
| Mild to Moderate Infections Adult: PO 125–500 mg q6h Child (<40 kg): PO 12.5–25 mg/kg q6h (max: 4 g/d) |
Administration
Oral- Give on an empty stomach at least 1 h before or 2 h after meals. Food reduces drug absorption.
- Reconstitute powder for oral suspension by shaking container to loosen powder. Add water according to label starting with half of the amount, then shake vigorously. Add remaining half and shake again vigorously. Shake well before each use.
- Store reconstituted oral suspensions for 7 d at room temperature (15°–30° C; 59°–86° F) or 14 d under refrigeration at 2°–8° C (36°–46° F). Date and label container. Store capsules at room temperature in tight containers unless otherwise directed.
Adverse Effects (≥1%)
Body as a Whole: Hypersensitivity (pruritus, urticaria, rash, wheezing, sneezing, anaphylaxis; eosinophilia). GI: Nausea, vomiting, flatulence, diarrhea, abdominal pain. Other: Transient elevations of ALT, superinfections.Interactions
Drug: Probenecid decreases dicloxacillin elimination.Pharmacokinetics
Absorption: 35–76% absorbed from GI tract. Peak: 0.5–2 h. Duration: 4–6 h. Distribution: Distributed throughout body with highest concentrations in liver and kidney; low CSF penetration; crosses placenta; distributed into breast milk. Metabolism: In liver. Elimination: Primarily in urine with some elimination through bile. Half-Life: 30–60 min.Nursing Implications
Assessment & Drug Effects
- Note: Take care to establish previous exposure and sensitivity to penicillins and cephalosporins as well as other allergic reactions of any kind before initiating therapy.
- Obtain C&S prior to initiation of therapy to determine susceptibility of causative organism. Therapy may begin pending test results.
- Lab tests: Baseline blood cultures, WBC, and differential counts and at least weekly for patients on prolonged therapy. Periodic ALT and AST determinations, urinalysis, BUN, and creatinine are also advised for these patients.
Patient & Family Education
- Take medication around the clock. Do not miss a dose and continue taking medication until it is all gone, unless otherwise directed by physician.
- Check with physician if GI side effects appear.
- Watch for and report the signs of hypersensitivity reactions and superinfections (see Appendix F).
Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; 
Canadian drug name; 
Prototype drug