Dosing and uses of Bactocill (oxacillin)
Adult dosage forms and strengths
infusion solution
- 1g/50mL
- 2g/50mL
powder for injection
- 1g
- 2g
- 10g
Staphylococcal Infections
Mild to moderate infections: 250-500 mg IV/IM q4-6hr
Severe infections: 1 g IV/IM q4-6hr
Acute/chronic osteomyelitis/staphylococci infections: 1.5-2 g IV q4-6hr
Renal Infection
CrCl < 10 mL/min: May consider adjusting to the lower range of the usually recommended dose depending on severity of infection
Pediatric dosage forms and strengths
infusion solution
- 1g/50mL
- 2g/50mL
powder for injection
- 1g
- 2g
- 10g
Susceptible Staph Infections in Infants & Children
Mild to moderate infections: 100-200 mg/kg/day IV/IM divided q6hr
Severe infections: 150-200 mg/kg/day IV/IM divided q6hr
Maximum 4g/day for mild to moderate infections
Maximum 12g/day for severe infections
Susceptible Staph Infections in Neonates
(<7 days old, <2 kg) OR (>7 days old, <1.2 kg): 50 mg/kg/day divided q12hr IV/Im
(<7 days old, >2 kg) OR (>7 days old, 1.2-2 kg): 75 mg/kg/day divided q8hr IV/Im
>7 days old, >2 kg: 100 mg/kg/day divided q6hr IV/Im
Bactocill (oxacillin) adverse (side) effects
1-10%
Diarrhea
Nausea
Fever
Rash
<1%
Eosinophilia
Leukopenia
Neutropenia
Thrombocytopenia
Hepatotoxicity
Elevated ASt
Acute interstitial nephritis
Serum sickness-like reaction
Warnings
Contraindications
Allergy to penicillins, cephalosporins, imipenem
Solutions containing dextrose may be contraindicated in patients with known allergy to corn or corn products
Cautions
Evaluate renal, hepatic, hematologic systems periodically during prolonged treatment
Monitor neonates for renal impairment
Monitor organ systems/serum concentrations of drug in neonates
Prolonged treatment may result in bacterial or fungal superinfection
Clostridium difficile associated diarrhea (CDAD) must be considered in all patients who present with diarrhea following antibiotic; CDAD has been reported to occur over two months after the administration of antibacterial agents; careful medical history is necessary; if CDAD suspected or confirmed, ongoing antibiotic use not directed against C. difficile may need to be discontinued; appropriate fluid and electrolyte management, protein supplementation, antibiotic treatment of C. difficile, and surgical evaluation should be instituted as indicated
Pregnancy and lactation
Pregnancy category: B
Lactation: excreted in breast milk; use caution
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
Pharmacology of Bactocill (oxacillin)
Mechanism of action
Bactericidal antibiotic that inhibits cell wall synthesis by binding to one or more of the penicillin binding proteins. Used in the treatment of infections caused by penicillinase-producing staphylococci. May be used to initiate therapy when a staphylococcal infection is suspected.
Pharmacokinetics
Half-Life: 23-60 min (adults; prolonged in renal insufficiency); 0.9-1.8 hr (children)
Peak Plasma Time: 30-60 min
Protein binding: 94%
Distribution: Bile, synovial, pleural, peritoneal, pericardial fluids
Metabolism: Hepatic to active metabolites
Excretion: Urine and feces
Administration
IV Incompatibilities
Additive: amikacin(?), cytarabine
Syringe: caffeine
Y-site: Na bicarb, verapamiL
Aminoglycosides & tetracyclines, but compatibility depends on several factors (eg, concentrations of the drugs, specific diluents used, resulting pH, temperature)
IV Compatibilities
Solution: compatible w/ most common solvents
Additive: Chloramphenicol Na succinate, dopamine, KCl, verapamiL
Y-site (partial list): Acyclovir, diltiazem, fluconazole, heparin, hydromorphone, MgSO4, meperidine, morphine, KCl, vit B/C, zidovudine
IV/IM Preparation
IM Injection
- For IM injection, reconstitute by adding 5.7 or 11.4 mL of SWI to a vial containing 1 or 2 g of oxacillin, respectively, to provide solutions containing 167 mg of oxacillin per mL (250 mg/1.5 mL)
- Shake vials well
IV Injection
- For direct injection, prepare a solution containing approximately 100 mg/mL by adding 10 or 20 mL SWI, ½NS or NS to vials containing 1 or 2 g of oxacillin, respectively
Intermittent or Continuous IV Infusion
- For intermittent IV infusion, reconstitute vials containing 1 or 2 g as for direct IV injection & further dilute with a compatible IV solution to a concentration of 0.5-40 mg/mL
- Alternatively, reconstitute ADD-Vantage vials containing 1 or 2 g according to the mfr's directions
IV/IM Administration
Administer by IM injection or slow IV injection or infusion
IM: deep into a large muscle (eg, gluteus maximus) & care should be taken to avoid sciatic nerve injury
IV Injection: slowly over about 10 min
Intermittent or Continuous IV Infusion: injections should not be used in series connections with other plastic containers: could result in air embolism from residual air being drawn from primary container before administration of fluid from secondary container is complete
Storage
Oxacillin powder: store at controlled room temp
Oxacillin in dextrose injection: store <-20°C
