Penicillin (penicillinase-resistant penicillin)
Staphylococcus spp., Streptococcal spp.
Exerts bactericidal activity via inhibition of bacterial cell wall synthesis by binding one or more of the penicillin binding proteins (PBPs). Exerts bacterial autolytic effect by inhibition of certain PBPs related to the activation of a bacterial autolytic process.
Penicillins produce time-dependent killing
Cmax: 10-17mcg/ml; Oral bioavailability: 37%; Half-life: 0.8 hours; Table 6
Hematologic: agranulocytosis, eosinophilia, hemolytic anemia, neutropenia, inhibition of platelet aggregation
Renal: interstitial nephritis
CNS: seizures
Other: Jarisch-Herxheimer Reaction (fever, chills, sweating, tachycardia, hyperventilation, flushing, and myalgia)
Adults: 125-250 mg po q6h
Pediatric: > 1 month and < 40 kg: 12.5 - 25 mg/kg/day po in 4 divided doses
³ 40 kg: usual adult dose
Staphylococcal osteomyelitis: 50-100 mg/kg/day in 4 divided doses
Disease state based dosing:
Renal failure: not necessary
Contraindications/Warnings/Precautions:
Contraindications: Anaphylaxis to dicloxacillin or other penicillins
Precautions: Cephalosporin hypersensitivity
Dicloxacillin is an inducer of the cytochrome P450 3A4 isoenzyme. Caution should be exercised and monitoring is suggested when concomitantly administering dicloxacillin with drugs that have narrow therapeutic windows and are substrates of the CYP3A4 enzyme.
Contraceptives - decreased contraceptive effectiveness
Live Typhoid Vaccine - decreased immunological response to the typhoid vaccine
Probenecid - increased dicloxacillin levels
Warfarin - decreased anticoagulant effectiveness
Pregnancy:
Category B: No evidence of risk in humans but studies inadequate.
Monitoring Requirements:
Therapeutic: Culture and sensitivities, signs and symptoms of infection
Toxic: Periodic CBC, urinalysis, BUN, Creatinine, AST and ALT
Brand names/Manufacturer: