Oxacillin (Bactocill) is penicillinase-resistant penicillin (beta-lactam antibiotic) used in the treatment of susceptible gram-positive infections.

Oxacillin Uses:

• Staphylococcal infections:

  • Used for treatment of infections caused by penicillinase-producing staphylococci that have demonstrated susceptibility to the drug.
  • In suspected cases of resistant staphylococcal infections, empiric therapy.

• Limitations of use:

  • Oxacillin should not be used in infections caused by organisms susceptible to penicillin G. Use

• Off-Label:

  • Adult Catheter-related bloodstream infections.
  • Skin and soft tissue necrotizing infections.
  • Surgical site infections.

Oxacillin Dose in Adults

Note:

• May have a significant amount of sodium.
• Consult product-specific labeling for the amount.

Oxacillin Dose in the treatment of Catheter-related bloodstream infections (off-label use):

• IV:
• 2 g after every 4 hours (Mermel 2009)

Oxacillin Dose in the treatment of Endocarditis:

• Methicillin-susceptible Staphylococcus aureus (MSSA) (off-label dose; AHA [Baddour 2015]):

• IV:

  • Native valve endocarditis:

    • For 6 weeks, 12 g per day in 4 or 6 divided doses (ie, 2 g every 4 hours or 3 g every 6 hours).
  • Note:
    • Dosing intended for complicated right-sided infective endocarditis (IE) or left-sided IE.
    • 2 weeks of therapy may be adequate, for uncomplicated right-sided IE.

  • Prosthetic valve endocarditis:

    • For at least 6 weeks, 12 g per day in 6 divided doses (ie, 2 g every 4 hours) (use with rifampin for the entire course and gentamicin for first 2 weeks)

Oxacillin Dose in the treatment of Meningitis, bacterial: Methicillin-susceptible S. aureus: (off-label dose):

• IV:

  • 2 g every 4 hours.
  • If the organism is susceptible and prosthetic material is present, consider the addition of rifampin.

Oxacillin Dose in the treatment of Osteomyelitis, native vertebral (off-label dose):

• Staphylococcus (oxacillin-susceptible):

  • IV:
  •  For 6 weeks, 1.5-2 g every 4-6 hours or via continuous infusion.

Oxacillin Dose in the treatment of prosthetic joint infection:

• IV:
• With rifampin, 2 g every 4 hours

Dose in the treatment of methicillin-susceptible Staphylococcus aureus infections:

•  Including
  • brain abscess,
  • bursitis,
  • erysipelas,
  • mastitis,
  • mastoiditis,
  • osteomyelitis,
  • perinephric abscess,
  • pneumonia,
  • pyomyositis,
  • scalded skin syndrome, and
  • toxic shock syndrome:
• IV:
• 2 g every 4 hours

Oxacillin Dose in the treatment of Skin and soft tissue infections:

IV:

• Due to methicillin-susceptible Staphylococcus aureus (MSSA):

  • For 7 to 14 days, 1 to 2 g every 4 hours

Oxacillin Dose in the treatment of Necrotizing infection due to MSSA (off-label):

• Every 4 hours, 1 to 2 g
• Until further debridement is not necessary, continue, the patient has clinically improved, and the patient is afebrile for 48-72 hours

Oxacillin Dose in the treatment of Surgical site infections (trunk or extremity away from axilla or perineum) (off-label):

• IV:
• 2 g every 6 hours (IDSA [Stevens 2014])

Oxacillin Dose in Childrens

Oxacillin General dosing in susceptible infection:

• Mild to moderate infections:

  • Infants, Children, and Adolescents IM/ IV:
    • Every 6 hours, 100-150 mg/kg/day in divided doses.
    • Max daily dose: 4,000 mg per day

• Severe infections:

  • Infants, Children, and Adolescents (IM//IV):
    • Every 4 to 6 hours, 150-200 mg/kg/day in divided doses.
    • Max daily dose:
    • 12 g per day

Oxacillin Dose in the treatment of Endocarditis:

• Children and Adolescents (IV):

  •  Every 4 to 6 hours, 200 mg/kg/day in divided doses.
  • Max daily dose:
  • 12 g per day.
  • Treat for at least four weeks.
  • Extended durations may be needed.
  • May use in combination with gentamicin for some resistant organisms.

Oxacillin Dose in the treatment of Meningitis and Ventriculitis:

• Infants, Children, and Adolescents (IV):

  • Every 6 hours, 200 mg/kg/day in divided doses.
  • Max daily dose:
  • 12 g per day (IDSA [Tunkel 2004]; IDSA [Tunkel 2017])

Oxacillin Dose in the treatment of community-acquired (CAP) moderate to severe infection S. aureus (methicillin-susceptible) Pneumonia:

• Infants >3 months, Children, and Adolescents (IV):

  • Every 6 to 8 hours, 150-200 mg/kg/day divided (IDSA/PIDS [Bradley 2011])

Oxacillin Dose in the treatment of Skin and soft tissue infections:

• Infants, Children, and Adolescents:

  • Methicillin-susceptible Staphylococcus aureus (MSSA) IV:

    • Every 6 hours, 100-150 mg/kg/day in divided doses.
    • Max daily dose:
    • 12 g per day

  • Necrotizing infection due to MSSA (IV):

    • Every 6 hours, 200 mg/kg/day in divided doses.
    • Max daily dose:
    • 12 g per day.
  • Continue until further debridement is not necessary, the patient has clinically improved, and the patient is afebrile for 48-72 hours.

Oxacillin Pregnancy risk Category: B

• Oxacillin is absorbed into the amniotic fluid and detected in cord blood.
• Penicillin use by mothers has not been linked to an increase in the risk of adverse effects on fetal health.

Use of Oxacillin while breastfeeding

• Breast milk contains Oxacillin.
• The manufacturer suggests that nursing mothers be cautious when administering oxacillin.
• These effects may not be related to the dosage.

Oxacillin Dose in Kidney Disease:

• In the manufacturer's labeling, there are no dosage adjustments provided.
• However, if renal impairment is known or suspected, the manufacturer suggests considering a reduction in total dosage.

Oxacillin Dose in Liver Disease:

• In the manufacturer's labeling, there are no dosage adjustments provided.

Side effects of Oxacillin:

• Gastrointestinal:

  • Clostridioides Difficile Associated Diarrhea
  • Clostridioides Difficile Colitis

• Hepatic:

  • Hepatotoxicity
  • Increased Serum Aspartate Aminotransferase

• Renal:

  • Acute Interstitial Nephritis
  • Acute Renal Tubular Disease

Contraindications to Oxacillin:

• Hypersensitivity (eg anaphylaxis), to any penicillin or any component of the formulation.

Warnings and precautions

• Anaphylactic and hypersensitivity reactions

  • Patients who have received penicillin therapy for severe and sometimes fatal hypersensitivity reactions (anaphylactic) have been diagnosed.
  • This includes patients with a history beta-lactam hypersensitivity, multiple allergies history, or IgE-mediated reactions such as anaphylaxis (eg, angioedema, allergic urticaria).
  • Patients with history of severe allergies or asthma should be cautious.
  • Stop using the medication if you experience an allergic reaction and seek out appropriate treatment.

• Hepatitis

  • Acute hepatitis can sometimes be accompanied by leukopenia and rash. Reversible elevations in serum transaminases may also be reported.
  • After 2-3 weeks of therapy, symptoms will begin to appear.
  • Examine regularly during therapy.

• Superinfection

  • Extended use can lead to fungal or bacterial overinfections, such as C. difficile-associated diarrhea(CDAD) and pseudomembranous collitis.
  • CDAD was observed for >2 months after antibiotic treatment.

• Renal impairment

  • Be careful.
  • Recommendation to adjust dosage.

Oxacillin: Drug Interaction

Monitoring Parameters:

• During the first dose, observe for signs and symptoms of anaphylaxis.
• Examine periodic CBC, urinalysis, BUN, serum creatinine, AST and ALT,

How to administer Oxacillin?

IV:

• Administer IVP over 10 mins or IVPB (IV piggyback) over 30 mins.

Mechanism of action of Oxacillin:

• One or more penicillin-binding protein (PBPs) inhibits bacterial cell cell wall synthesis by binding.
• This in turn inhibits the final step of peptidoglycan transpeptidation in bacterial cells walls and thus, inhibits cell wall biosynthesis.
• Despite the fact that cell wall assembly is stopped, bacteria eventually lyses due to the ongoing activity of cell-wall autolytic enzymes (autolysins and murein hydrolases).

Distribution:

• Into bile, amniotic, and pleural fluids.
• In CSF and aqueous humor, insignificant concentrations

Protein binding:

• ~94 percent (mainly albumin)

Metabolism:

• Hepatic

Half-life elimination:

• Neonates (PNA: 8-15 days):
  • 1.6 hours
• Infants and Children ≤2 years:
  • 0.9-1.8 hours
• Adults:
  • 20-30 mins.
  • Prolonged with renal impairment

Time to peak serum concentration:

• IM:
  •  30 mins
• IV:
  • 5 mins

Excretion:

• Urine and bile (unchanged drug)

International Brands of Oxacillin:

• Bactocill in Dextrose
• Biotam
• Bristopen
• Cloxacap
• Cloxcin
• Minzil
• Ocillina
• Ocina
• Oxacilina
• Oxacillin
• Oxan
• Oxanon
• Oxapen
• Oxatalis
• Penstapho
• Procillin
• Prostafilina
• Prostaphlin
• Stapenor
• Syntarpen
• Wydox

Oxacillin Brand Names in Pakistan:

No Brands Available in Pakistan.