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

Oxacillin Uses:

• Staphylococcal infections:

  • used to treat infections brought on by staphylococci that produce penicillinase and have shown the drug's resistance.
  • empiric therapy in cases when resistant staphylococcal infections are suspected.

• Limitations of use:

  • Infections brought on by microorganisms susceptible to penicillin G shouldn't be treated with oxyacillin.

• Off-Label:

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

Oxacillin Dose in Adults

Note:

• It can include a lot of sodium.
• For the amount, check the labelling on the individual product.

Dose for treating Catheter-related bloodstream infections (off-label use):

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

Dose for treating Endocarditis:

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

• IV:

  • Native valve endocarditis:

    • 12 g every day, divided into 4 or 6 dosages, for six weeks (ie, 2 g every 4 hours or 3 g every 6 hours).
  • Note:
    • Intended dosage for either left- or right-sided complex infective endocarditis (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)

Dose for treating Meningitis, bacterial: Methicillin-susceptible S. aureus: (off-label dose):

• IV:

  • Every four hours, 2 g.
  • Rifampin may be added if the organism is sensitive and there is prosthetic material present.

Dose for treating Osteomyelitis, native vertebral (off-label dose):

• Staphylococcus (oxacillin-susceptible):

  • IV:
  • 1.5–2 g every 4–6 hours for 6 weeks, or continuously infused.

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

Dose for treating Skin and soft tissue infections:

IV:

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

  • 1 to 2 g every 4 hours for 7 to 14 days.

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

• 1–2 g every 4 hours
• Continue until no more debridement is required, the patient has shown clinical improvement, and the patient has been 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 in 6 hours (IDSA [Stevens 2014])

Oxacillin Dose in Children

Oxacillin General dosing in susceptible infection:

• Mild to moderate infections:

  • Infants, Children, and Adolescents IM/ IV:
    • 100-150 mg/kg/day divided into every 6 hours.
    • Maximum dosage daily: 4,000 mg daily

• Severe infections:

  • Infants, Children, and Adolescents (IM//IV):
    • 150–200 mg/kg/day divided into every 4–6 hours.
    • Maximum daily dose: 12 g daily

Oxacillin Dose in the treatment of Endocarditis:

• Children and Adolescents (IV):

  • A split dose of 200 mg/kg/day given every 4 to 6 hours.
  • Maximum daily dose: 12 g.
  • Treat for at least four weeks.
  • Longer times may be required.
  • For some resistant organisms, gentamicin may be used in combination.

Oxacillin Dose in the treatment of Meningitis and Ventriculitis:

• Infants, Children, and Adolescents (IV):

  • Every 6 hours, 200 mg per kg per 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 per kg per day in divided doses.
    • Max daily dose 12 g per day

  • Necrotizing infection due to MSSA (IV):

    • Every 6 hours, 200 mg per kg per 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 enters the amniotic fluid and is found in the cord blood.
• Mothers who use penicillin do not raise their chance of negative foetal health impacts, according to research.

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:

• Be on the lookout for anaphylactic symptoms and indications during the first dose.
• Check regular CBC, urinalysis, BUN, serum creatinine, AST, and ALT results.

How to administer Oxacillin?

IV:

• IVP should be given over ten minutes, and IVPB (IV piggyback) over thirty.

Mechanism of action of Oxacillin:

• By binding, one or more penicillin-binding proteins (PBPs) prevent the production of the bacterial cell wall.
• This in turn inhibits the final step of peptidoglycan transpeptidation in bacterial cells walls and thus, inhibits cell wall biosynthesis.
• Bacteria eventually lyses despite the fact that cell wall synthesis is ceased because of the continued action 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.