Yes

Antibiotic, Penicillin

Dental: Treatment of susceptible orofacial infections, notably penicillinase-producing staphylococci

Medical: Treatment of susceptible bacterial infections, notably penicillinase-producing staphylococci causing respiratory tract, skin and skin structure, bone and joint, urinary tract infections

B

Hypersensitivity to cloxacillin or any component, or penicillins

Monitor PT if patient concurrently on warfarin, elimination of drug is slow in renally impaired; use with caution in patients allergic to cephalosporins due to a low incidence of cross-hypersensitivity

1% to 10%: Gastrointestinal: Nausea, diarrhea, abdominal pain

<1%: Fever, seizures with extremely high doses and/or renal failure, rash (maculopapular to exfoliative), vomiting, pseudomembranous colitis, vaginitis, eosinophilia, leukopenia, neutropenia, thrombocytopenia, agranulocytosis, anemia, hemolytic anemia, prolonged PT, hepatotoxicity, transient elevated LFTs, hematuria, interstitial nephritis, increased BUN/creatinine, serum sickness-like reactions, hypersensitivity

Symptoms of penicillin overdose include neuromuscular hypersensitivity (agitation, hallucinations, asterixis, encephalopathy, confusion, and seizures) and electrolyte imbalance with potassium or sodium salts, especially in renal failure

Hemodialysis may be helpful to aid in the removal of the drug from the blood, otherwise most treatment is supportive or symptom directed

Decreased effect: Efficacy of oral contraceptives may be reduced

Increased effect: Disulfiram, probenecid may increase penicillin levels, increased effect of anticoagulants

Refrigerate oral solution after reconstitution; discard after 14 days; stable for 3 days at room temperature

Inhibits bacterial cell wall synthesis by binding to one or more of the penicillin-binding proteins (PBPs) which in turn inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell walls, thus inhibiting cell wall biosynthesis. Bacteria eventually lyse due to ongoing activity of cell wall autolytic enzymes (autolysins and murein hydrolases) while cell wall assembly is arrested.

Absorption: Oral: ~50%

Distribution: Crosses the placenta; appears in breast milk; distributed widely to most body fluids and bone; penetration into cells, into the eye, and across normal meninges is poor; inflammation increased amount that crosses the blood-brain barrier

Protein binding: 90% to 98%

Metabolism: Significant in the liver to active and inactive metabolites

Half-life: 0.5-1.5 hours (prolonged with renal impairment and in neonates)

Time to peak serum concentration: Oral: Within 0.5-2 hours

Elimination: In urine and through bile

Oral:

Children (>20 kg) and Adults: 250-500 mg every 6 hours

Hemodialysis: Not dialyzable (0% to 5%)

Should be taken 1 hour before or 2 hours after meals with water

Observe for signs and symptoms of anaphylaxis during first dose

May interfere with urinary glucose tests using cupric sulfate (Benedict's solution, Clinitest®); may inactivate aminoglycosides in vitro; false-positive urine and serum proteins; false-positive in uric acid, urinary steroids

Penicillins have been reported to cause apprehension, illusions, agitation, insomnia, depersonalization, and encephalopathy

Rare reports of agranulocytosis; use caution with clozapine and carbamazepine

No information available to require special precautions

Prolonged use of penicillins may lead to development of oral candidiasis

Take 1 hour before or 2 hours after meals with water. Finish all medication; do not skip doses. Take around-the-clock. If diabetic, drug may cause false tests with Clinitest® urine glucose monitoring; use of glucose oxidase methods (Clinistix®) or serum glucose monitoring is preferable. This drug may interfere with oral contraceptives; an alternate form of birth control should be used. Immediately report any signs or symptoms of anaphylactic reactions (eg, chills, fever, wheezing, tightness in chest), excessive GI side effects, or signs or symptoms of opportunistic infection (eg, white spots or sores in mouth, vaginal discharge or sores, fever, fatigue, unhealed sores or wounds). Breast-feeding precautions: Inform prescriber if breast-feeding.

Monitor CBC with differential, urinalysis, BUN, serum creatinine, and liver enzymes

Capsule, as sodium: 250 mg, 500 mg

Powder for oral suspension, as sodium: 125 mg/5 mL (100 mL, 200 mL)

Bluhm G, Jacobson B, Julander I, et al, "Antibiotic Prophylaxis in Pacemaker Surgery - A Prospective Study," Scand J Thorac Cardiovasc Surg, 1984, 18(3):227-34.

Donowitz GR and Mandell GL, "Beta-Lactam Antibiotics," N Engl J Med, 1988, 318(7):419-26 and 318(8):490-500.

Wright AJ, "The Penicillins," Mayo Clin Proc, 1999, 74(3):290-307.