Yes

Antibiotic, Penicillin

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

B

Known hypersensitivity to dicloxacillin, penicillin, or any components

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

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; decreased effect of warfarin

Increased effect: Disulfiram, probenecid may increase penicillin levels

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

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: 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

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

Food: Decreases drug absorption rate; decreases drug serum concentration. Administer on an empty stomach 1 hour before or 2 hours after meals.

Monitor prothrombin time if patient concurrently on warfarin; monitor for signs of anaphylaxis during first dose

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

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

Rarely may cause 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 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.

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

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)

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.