Oxacillin

General
  • Type: Anti-Staphylococcal Penicillin
  • Dosage Forms: IM; IV
  • Common Trade Names: Bactocill

Adult Dosing

General
  • Mild-to-moderate infection
    • 250-500mg IM/IV q4-6 hours
  • Severe infection
    • 1g IM/IV q4-6 hours

Endocarditis

Prosthetic Joint Infection

MSSA

Pediatric Dosing

General
  • Mild-to-moderate
    • 50mg/kg/day IM/IV divided q6 hours
    • First Dose: 12.5mg/kg IM/IV x 1
    • Max: 4 g/day
  • Severe
    • 100mg/kg/day IM/IV divided q4-6 hours
    • First Dose: 16.6-25mg/kg IM/IV x 1
    • Max: 12 g/day

Community-Acquired Pneumonia (>3 Months)[1]
  • 150-200mg/kg/day divided q6-8 hours
  • First Dose: 37.5-66.6mg/kg IV x 1
  • For MSSA

Special Populations
  • Pregnancy Rating: B
  • Lactation: Use caution
  • Renal Dosing
    • Adult: No adjustment
    • Pediatric:
      • CrCl <10: Use lower end of dosing range
  • Hepatic Dosing
    • Adult: Not defined
    • Pediatric: Not defined

Contraindications
  • Allergy to class/drug
  • Caution:
    • Non-anaphylactic hypersensitivity to beta-lactams
    • Hypersensitivity to corn
    • Asthma
    • Recent abx-associated colitis
    • Renal impairment
    • Sodium restriction
    • Seizure disorder

Adverse Reactions

Serious

Common

Pharmacology
  • Half-life: 20-60 minutes (prolonged in neonates and renal impairment)
  • Metabolism: Liver 45%; active metabolite
  • Excretion: Urine (55-60% unchanged), Bile 10%
  • Mechanism of Action: Bactericidal; inhibits cell wall mucopeptide synthesis

Antibiotic Sensitivities[2]
Group Organism Sensitivity
Gram PositiveStrep. Group A, B, C, GS
Strep. PneumoniaeS
Viridans strepI
Strep. anginosus gpS
Enterococcus faecalisR
Enterococcus faeciumR
MSSAS
MRSAR
CA-MRSAR
Staph. EpidermidisS
C. jeikeiumR
L. monocytogenesR
Gram NegativesN. gonorrhoeaeR
N. meningitidisR
Moraxella catarrhalisR
H. influenzaeR
E. coliR
Klebsiella spR
E. coli/Klebsiella ESBL+R
E coli/Klebsiella KPC+R
Enterobacter sp, AmpC negR
Enterobacter sp, AmpC posR
Serratia spR
Serratia marcescensX1
Salmonella spR
Shigella spR
Proteus mirabilisR
Proteus vulgarisR
Providencia sp.R
Morganella sp.R
Citrobacter freundiiR
Citrobacter diversusR
Citrobacter sp.R
Aeromonas spR
Acinetobacter sp.R
Pseudomonas aeruginosaR
Burkholderia cepaciaR
Stenotrophomonas maltophiliaR
Yersinia enterocoliticaR
Francisella tularensisX1
Brucella sp.X1
Legionella sp.R
Pasteurella multocidaR
Haemophilus ducreyiX1
Vibrio vulnificusX1
MiscChlamydophila spR
Mycoplasm pneumoniaeR
Rickettsia spX1
Mycobacterium aviumX1
AnaerobesActinomycesR
Bacteroides fragilisR
Prevotella melaninogenicaR
Clostridium difficileX1
Clostridium (not difficile)X1
Fusobacterium necrophorumX1
Peptostreptococcus sp.S

Key
  • S susceptible/sensitive (usually)
  • I intermediate (variably susceptible/resistant)
  • R resistant (or not effective clinically)
  • S+ synergistic with cell wall antibiotics
  • U sensitive for UTI only (non systemic infection)
  • X1 no data
  • X2 active in vitro, but not used clinically
  • X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
  • X4 active in vitro, but not clinically effective for strep pneumonia

See Also

References
  1. IDSA/PIDS, 2011
  2. Sanford Guide to Antimicrobial Therapy 2014
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