Oral Infections caused by susceptible penicillinase-producing staphylococci
Adult: Usual dose: In mild to moderate infections: 125 mg 6 hourly. In severe infections: 250 mg 6 hourly; continue therapy for at least 14 days. Higher doses may be necessary based on infection severity. Dosage and treatment duration may vary according to the type and severity of infection, and the patient's clinical and bacteriological response. Child: Children weighing <40 kg: Usual dose: In mild to moderate infections: 12.5 mg/kg 6 hourly. In severe infections: 25 mg/kg 6 hourly; ≥40 kg: Same as adult dose. Higher doses may be necessary based on infection severity. Dosage and treatment duration may vary according to the type and severity of infection, and the patient's clinical and bacteriological response.
Renal Impairment
Dosage adjustment may be required.
Administration
Should be taken on an empty stomach.
Contraindications
Hypersensitivity to dicloxacillin, other penicillins, or cephalosporins.
Special Precautions
Patient with a history of significant allergy and/or asthma. Renal and hepatic impairment. Children. Pregnancy and lactation. Not indicated for use in infections caused by organisms susceptible to benzylpenicillin. Not intended for initial treatment of severe, life-threatening infections.
Adverse Reactions
Significant: Bacterial or fungal superinfection, including pseudomembranous colitis and C. difficile-associated diarrhoea (prolonged use). Blood and lymphatic system disorders: Eosinophilia, agranulocytosis, neutropenia, haemolytic anaemia, leucopenia, thrombocytopenia. Gastrointestinal disorders: Nausea, vomiting, abdominal pain or discomfort, diarrhoea, flatulence, stomatitis, black or hairy tongue. Immune system disorders: Serum sickness-like reaction. Investigations: Increased liver enzymes (transient). Renal and urinary disorders: Haematuria, interstitial nephritis. Skin and subcutaneous tissue disorders: Rash, urticaria, pruritus. Potentially Fatal: Serious hypersensitivity reactions (e.g. anaphylactic shock with collapse).
Perform culture and susceptibility tests; consult local institutional recommendations before treatment initiation due to antibiotic resistance risks. Obtain CBC with differential at baseline and at least every week during therapy; urinalysis, serum creatinine, BUN, ALT and AST periodically during treatment (especially with prolonged use); prothrombin time (if patient is on concurrent warfarin therapy). Monitor for signs and symptoms of anaphylaxis during 1st dose.
Drug Interactions
Tetracycline may diminish the bactericidal effect of dicloxacillin. Increased and prolonged serum concentrations with probenecid. May diminish the anticoagulant effect of warfarin.
Food Interaction
Food reduces the absorption of dicloxacillin.
Lab Interference
May cause false-positive results for urine and serum proteins, uric acid and urinary steroids. May interfere with urinary glucose tests that use cupric sulfate (e.g. Benedict's solution, Clinitest®).
Action
Description: Mechanism of Action: Dicloxacillin is a semisynthetic penicillinase-resistant penicillin that blocks cell wall synthesis by binding to 1 or more penicillin-binding proteins (PBPs) which in turn inhibits the final transpeptidation step of bacterial peptidoglycan cell wall synthesis. This results in bacterial lysis due to the ongoing activity of cell wall autolytic enzymes (autolysins and murein hydrolases) while arresting cell wall assembly. Pharmacokinetics: Absorption: Rapidly but incompletely absorbed from the gastrointestinal tract. Absorption is reduced with food. Bioavailability: 49-76%. Time to peak plasma concentration: 1-1.5 hours. Distribution: Distributed in bone, body tissues and body fluids. Low CSF penetration. Crosses the placenta; enters breast milk. Volume of distribution: 5.99 L. Plasma protein binding: 95-99%, mainly to albumin. Metabolism: Partially metabolised into active and inactive metabolites. Excretion: Mainly via urine (31-65%, as unchanged drug and active metabolite); faeces. Elimination half-life: Approx 0.7 hours.
Chemical Structure
Source: National Center for Biotechnology Information. PubChem Database. Dicloxacillin, CID=18381, https://pubchem.ncbi.nlm.nih.gov/compound/Dicloxacillin (accessed on Jan. 21, 2020)
J01CF01 - dicloxacillin ; Belongs to the class of beta-lactamase resistant penicillins. Used in the systemic treatment of infections.
References
Anon. Dicloxacillin. AHFS Clinical Drug Information [online]. Bethesda, MD. American Society of Health-System Pharmacists, Inc. https://www.ahfscdi.com. Accessed 29/10/2021.Anon. Dicloxacillin. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 29/10/2021.Buckingham R (ed). Dicloxacillin. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 29/10/2021.Dicloxacillin Sodium (A-S Medication Solutions). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 29/10/2021.GPO Diclox Capsules (GPO [The Government Pharmaceutical Organization]). MIMS Thailand. http://www.mims.com/thailand. Accessed 10/11/2021.
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