Adult Dosing
Penicillinase-producing staphylococci infection
- Mild-moderate infection: 250-500 mg IM/IV q4-6 hrs
- Severe infection: 1-2 g IM/IV q4-6 hrs
Notes:- In severe infection continued the treatment for at least 14 days
- Continue the treatment for at least 48 hrs after the patient has become afebrile, asymptomatic, and cultures are negative
Pediatric Dosing
Penicillinase-producing staphylococci infection
Infants and children <40 kg
- Mild-moderate infection: 50 mg/kg/day IM/IV in equally divided doses q6 hrs
- Severe infection: 100-200 mg/kg/day IM/IV in equally divided doses q4-6 hrs
Premature and neonates
Notes:- In severe infection continued the treatment for at least 14 days
- Continue the treatment for at least 48 hrs after the patient has become afebrile, asymptomatic, and cultures are negative
- Serious and fatal hypersensitivity reactions including anaphylactic shock have been reported in patients receiving penicillin. Hence before initiating penicillin therapy obtain comprehensive patient drug and allergy history
- Discontinue the treatment if an allergic reaction occurs, and provide immediate supportive treatment, e.g., artificial maintenance of ventilation, pressor amines, antihistamines, and corticosteroids
- Patients with the history of penicillin hypersensitivity may also experience allergic reactions when treated with a cephalosporin
- Clostridium difficile associated diarrhea (CDAD) ranging from mild diarrhea to fatal colitis occurs with oxacillin therapy as antibacterial agents alters the normal flora of the colon leading to overgrowth of C. difficile
- C. difficile produces toxins A and B which contribute to CDAD. Hypertoxin producing strains causes increased morbidity and mortality since these infections can be refractory to antibiotic therapy and may require colectomy. Careful medical examination is necessary since CDAD may occur >2 months after administration of drug
- If CDAD is suspected/confirmed discontinue the treatment, provide fluid, electrolyte, and protein supplementation along with antibiotics for C. difficile, surgical evaluation as clinically needed
- Superinfections due to bacteria or fungi can occur with oxacillin; discontinue therapy and/or institute appropriate therapy if such infections occur
- Prescribing antibiotics in the absence of proven or strongly suspected bacterial infection increases the risk of development of drug-resistant bacteria
Cautions: Use cautiously in
- Renal impairment
- Hepatic impairment
- History of sensitivity to any penicillin
- Sensitivity to cephalosporins
- History of significant allergies or asthma
Pregnancy Category:B
Breastfeeding: As per limited data maternal doses of oxacillin up to 4 g daily produce low levels in milk that are not expected to cause adverse effects in breastfed infants, hence oxacillin is acceptable to use during breastfeeding. Occasionally, disruption of the infant's gastrointestinal flora, resulting in diarrhea or thrush, has been reported with penicillins, but has not been adequately evaluated. Based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 09 June 2011). Manufacturer advises caution.
