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Pronunciation |
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(dye
kloks a SIL
in) |
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U.S. Brand
Names |
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Dycill®; Dynapen®;
Pathocil® |
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Generic
Available |
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Yes |
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Synonyms |
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Dicloxacillin Sodium |
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Pharmacological Index |
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Antibiotic, Penicillin |
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Use |
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Dental: Treatment of susceptible orofacial infections, notably
penicillinase-producing staph
Medical: Treatment of systemic infections such as pneumonia, skin and soft
tissue infections, and osteomyelitis caused by penicillinase-producing
staphylococci |
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Pregnancy Risk
Factor |
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B |
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Contraindications |
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Known hypersensitivity to dicloxacillin, penicillin, or any
components |
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Warnings/Precautions |
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Monitor PT if patient concurrently on warfarin; elimination of drug is slow
in neonates; use with caution in patients allergic to cephalosporins; bad taste
of suspension may make compliance difficult |
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Adverse
Reactions |
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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 |
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Overdosage/Toxicology |
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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 |
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Drug
Interactions |
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Decreased effect: Efficacy of oral contraceptives may be reduced; decreased
effect of warfarin
Increased effect: Disulfiram, probenecid may increase penicillin levels
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Stability |
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Refrigerate suspension after reconstitution; discard after 14 days if
refrigerated or 7 days if kept at room temperature; unit dose antibiotic oral
syringes are stable for 48 hours |
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Mechanism of
Action |
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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. |
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Pharmacodynamics/Kinetics |
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Absorption: 35% to 76% from GI tract; food decreases rate and extent of
absorption
Distribution: Crosses the placenta; distributes into breast milk; distributed
throughout body with highest concentrations in kidney and liver; CSF penetration
is low
Protein binding: 96%
Half-life: 0.6-0.8 hours, slightly prolonged in patients with renal
impairment
Time to peak serum concentration: Within 0.5-2 hours
Elimination: Prolonged in neonates; partially eliminated by the liver and
excreted in bile, 56% to 70% is eliminated in urine as unchanged drug
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Usual Dosage |
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Oral:
Children <40 kg: 12.5-25 mg/kg/day divided every 6 hours; doses of 50-100
mg/kg/day in divided doses every 6 hours have been used for therapy of
osteomyelitis
Children >40 kg and Adults: 125-250 mg every 6 hours
Dosage adjustment in renal impairment: Not necessary
Hemodialysis: Not dialyzable (0% to 5%); supplemental dosage not necessary
Peritoneal dialysis: Supplemental dosage not necessary
Continuous arteriovenous or venovenous hemofiltration (CAVH/CAVHD):
Supplemental dosage not necessary |
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Dietary
Considerations |
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Food: Decreases drug absorption rate; decreases drug serum concentration.
Administer on an empty stomach 1 hour before or 2 hours after
meals. |
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Monitoring
Parameters |
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Monitor prothrombin time if patient concurrently on warfarin; monitor for
signs of anaphylaxis during first dose |
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Test
Interactions |
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False-positive urine and serum proteins; false-positive in uric acid, urinary
steroids; may interfere with urinary glucose tests using cupric sulfate
(Benedict's solution, Clinitest®); may inactivate
aminoglycosides in vitro |
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Mental Health: Effects
on Mental Status |
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Penicillins have been reported to cause apprehension, illusions, agitation,
insomnia, depersonalization, and encephalopathy |
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Mental Health:
Effects on Psychiatric
Treatment |
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Rarely may cause agranulocytosis; use caution with clozapine and
carbamazepine |
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Dental Health: Local
Anesthetic/Vasoconstrictor
Precautions |
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No information available to require special precautions |
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Dental Health:
Effects on Dental Treatment |
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Prolonged use of penicillins may lead to development of oral
candidiasis |
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Patient
Information |
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Take medication as directed, with a large glass of water 1 hour before or 2
hours after meals. Take at regular intervals around-the-clock and take for
length of time prescribed. You may experience some gastric distress (small
frequent meals may help) and diarrhea (if this persists, consult prescriber). 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. Report fever, vaginal itching, sores in the mouth, loose
foul-smelling stools, yellowing of skin or eyes, and change in color of urine or
stool. Breast-feeding precautions: Consult prescriber if
breast-feeding. |
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Nursing
Implications |
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Administer around-the-clock rather than 4 times/day, 3 times/day, etc, (ie,
12-6-12-6, not 9-1-5-9) to promote less variation in peak and trough serum
levels
Monitor periodic monitoring of CBC, urinalysis, BUN, serum creatinine, and
liver enzymes during prolonged therapy |
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Dosage Forms |
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Capsule, as sodium: 125 mg, 250 mg, 500 mg
Powder for oral suspension, as sodium: 62.5 mg/5 mL (80 mL, 100 mL, 200 mL)
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References |
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Donowitz GR and Mandell GL, "Beta-Lactam Antibiotics," N Engl J Med,
1988, 318(7):419-26 and 318(8):490-500.
Pacifici GM, Viani A, Taddeucci-Brunelli G, et al,
"Plasma Protein Binding of Dicloxacillin: Effects of Age and Diseases," Int J
Clin Pharmacol Ther Toxicol, 1987, 25(11):622-6.
Wright AJ, "The Penicillins," Mayo Clin Proc, 1999, 74(3):290-307.
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