Dicloxacillin

What is Dicloxacillin?

• Dicloxacillin (Dycill; Dynapen; Pathocil), is a semisynthetic antibiotic substance which resists destruction by the enzyme penicillinase(beta - lactamase).
• It is a second generation penicillin antibiotic that is used to treat bacterial infections caused by penicillinase-resistant staphylococci.

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Dicloxacillin

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Dicloxacillin Structure

What are the uses of this medicine?

• Dicloxacillin (Dycill; Dynapen; Pathocil), is used in the treatment of infections caused by penicillinase-producing staphylococci.
• To decrease the development of resistance, dicloxacillin is recommended to treat infections that are suspected or proven to be caused by beta-lactamase-producing bacteria.

Dicloxacillin is used for the treatment of infections caused by susceptible bacteria.

Specific approved indications include:

• Staphylococcal skin infections and cellulitis – including impetigo, otitis externa, folliculitis, boils, carbuncles, and mastitis
• Pneumonia (adjunct)
• Osteomyelitis, septic arthritis, throat infections, streptococcus
• Septicaemia
• Empirical treatment for endocarditis
• Surgical prophylaxis

How does this medicine work?

• The sodium salt form of dicloxacillin, a broad-spectrum, semi-synthetic beta-lactam with bactericidal and beta-lactamase resistant activity.
• Dicloxacillin sodium binds to penicillin binding proteins (PBP) located on the inner membrane of the bacterial cell wall.
• It also inhibits the cross-linkage of peptidoglycan, a critical component of bacterial cell walls.
• This leads to the inhibition of bacterial cell wall synthesis and eventually causes cell lysis.

Dicloxacillin sodium has been shown to be active against most isolates of the following microorganisms: Aerobic Gram-Positive Microorganisms:

• Staphylococcus spp.

Who Should Not Use this medicine ?

This medicine cannot be used in patients who:

• have shown hypersensitivity to any of the penicillins or any component of the formulations.

What drug interactions can this medicine cause?

• Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.

Be sure to mention any of the following:

• probenecid (Probalan, in Col-probenecid)
• tetracycline antibiotics such as demeclocycline, doxycycline (Doxy, Oracea, Vibramycin, others), minocycline (Dynacin, Minocin, Solodyn, others), tetracycline (Achromycin V, in Pylera), and tigecycline (Tygacil)
• warfarin (Coumadin, Jantoven)

Is this medicine FDA approved?

• Dicloxacillin was approved for use in the United States in 1968 and is still widely used to treat mild-to-moderate staphylococcal infections.
• To reduce development of drug resistant bacteria, dicloxacillin is recommended to treat or prevent only those infections that are proven or suspected to be caused by penicillinase-producing susceptible bacteria.

How should this medicine be used?

Recommended dosage:

In Adults: For Mild to Moderate infection:

• 125 mg every 6 hours.

For Severe Infection:

• 250 mg every 6 hours.

In Children: For Mild to Moderate infection:

• 12.5 mg/kg/day in equally divided doses every 6 hours.

For Severe Infection:

• 25 mg/kg/ day* in equally divided doses every 6 hours.

Administration:

• Dicloxacillin comes as a capsule to take by mouth.
• It is usually taken every 6 hours (four times a day).
• Dicloxacillin should be taken on an empty stomach at least 1 hour before or 2 hours after a meal or snack, The length of your treatment depends on the type of infection that you have.
• Take dicloxacillin at around the same times every day.
• Take dicloxacillin while you are sitting or standing up with at least 4 ounces (120 mL) of water.
• Do not lay down or go to sleep immediately after taking dicloxacillin.
• Take dicloxacillin until you finish the prescription, even if you feel better.
• Do not stop taking dicloxacillin without talking to your doctor.
• If you stop taking dicloxacillin too soon or if you skip doses, your infection may not be completely treated and the bacteria may become resistant to antibiotics.

What are the dosage forms and brand names of this medicine?

This medicine is available in fallowing doasage form:

• As capsule for oral administration contains dicloxacillin sodium, USP equivalent to 250 or 500 mg of dicloxacillin.

This medicine is available in fallowing brand namesː

• Dycill; Dynapen; Pathocil

What side effects can this medication cause?

The most common side effects of this medicine include:

• nausea, diarrhea, stomatitis, skin rash, swollen joints and allergic reactions.

Less common,but serious side effects may include:

• Hypersensitive Reactions: anaphylactic reactions, urticaria, pruritus, and fever. Although laryngeal edema, laryngospasm, and hypotension.
• Gastrointestinal Reactions: Nausea, vomiting, diarrhea, stomatitis, black or hairy tongue, and other symptoms of gastrointestinal irritation.
• Nervous System Reactions: lethargy, confusion, twitching, multifocal myoclonus, localized or generalized epileptiform seizures.
• Renal Reactions: rash, fever, eosinophilia, hematuria, proteinuria, and renal insufficiency.
• Hematologic Reactions: Eosinophilia, hemolytic anemia, agranulocytosis, neutropenia, leukopenia, granulocytopenia, thrombocytopenia, and bone marrow depression.
• Hepatic Reactions: fever, nausea, and vomiting associated with abnormal liver function tests, mainly elevated AST (SGOT) levels.

• Cholestatic hepatitis has been reported rarely. Asymptomatic, transient increases in serum concentrations of alkaline phosphatase, AST (SGOT), and ALT (SGPT) have been reported.

What special precautions should I follow?

• Serious and occasionally fatal hypersensitivity (anaphylactic shock with collapse) reactions have occurred in patients receiving penicillin. If an allergic reaction occurs, dicloxacillin should be discontinued and appropriate therapy instituted. Individuals with a history of penicillin hypersensitivity may also experience allergic reactions when treated with a cephalosporin.
• Clostridium difficile associated diarrhea (CDAD) has been reported with use of nearly all antibacterial agents, including dicloxacillin sodium, and may range in severity from mild diarrhea to fatal colitis. Treatment with antibacterial agents alters the normal flora of the colon leading to overgrowth of C. difficile.
• If CDAD is suspected or confirmed, ongoing antibiotic use not directed against C. difficile may need to be discontinued. Appropriate fluid and electrolyte management, protein supplementation, antibiotic treatment of C. difficile, and surgical evaluation should be instituted as clinically indicated.
• Penicillinase-resistant penicillins should generally not be administered to patients with a history of sensitivity to any penicillin.
• Penicillin should be used with caution in individuals with histories of significant allergies and/or asthma.
• Prescribing dicloxacillin sodium capsules in the absence of a proven or strongly suspected bacterial infection or a prophylactic indication is unlikely to provide benefit to the patient and increases the risk of the development of drug-resistant bacteria.
• Because most antibacterial drugs taken by mouth are best absorbed on an empty stomach, patients should be directed, unless circumstances warrant otherwise, to take penicillin one hour before meals or two hours after eating.
• Patients should be told to take the entire course of therapy prescribed, even if fever and other symptoms have stopped.
• If any of the following reactions occur, stop taking your prescription and notify the physician: shortness of breath, wheezing, skin rash, mouth irritation, black tongue, sore throat, nausea, vomiting, diarrhea, fever, swollen joints, or any unusual bleeding or bruising.
• Do not take any additional medications without physician approval, including non-prescription drugs such as antacids, laxatives, or vitamins.
• Patients should be counseled that antibacterial drugs including dicloxacillin sodium capsules should only be used to treat bacterial infections. They do not treat viral infections (e.g., the common cold).
• Dicloxacillin has been linked to rare instances of clinically apparent, idiosyncratic liver injury.
• Penicillins are excreted in breast milk. Caution should be exercised when penicillins are administered to a nursing woman.

What to do in case of emergency/overdose?

• In case of overdose, call the poison control helpline of your country. In the United States, call 1-800-222-1222.

• Overdose related information is also available online at poisonhelp.org/help.
• In the event that the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services. In the United States, call 911.

Can this medicine be used in pregnancy?

• There are, however, no adequate or well-controlled studies in pregnant women showing conclusively that harmful effects of these drugs on the fetus can be excluded.
• Because animal reproduction studies are not always predictive of human response, this drug should be used during pregnancy only if clearly needed.

Can this medicine be used in children?

• Frequent blood levels are advisable in this group with dosage adjustments when necessary.

What are the active and inactive ingredients in this medicine?

Active ingredient:

• dicloxacillin sodium

Inactive ingredients:

• magnesium stearate
• The capsule shells contain FD&C Blue 1, titanium dioxide, and gelatin. The capsule ink contains shellac, propylene glycol, black iron oxide, ammonium hydroxide and potassium hydroxide

Who manufactures and distributes this medicine?

• Manufactured by: Sandoz GmbH for Sandoz Inc., Princeton, NJ

What should I know about storage and disposal of this medication?

• Store at 20° to 25°C (68° to 77°F).

Penicillin antibiotics

• penicillins first generation (natural penicillins)
  • benzathine penicillin, procaine penicillin, penicillin g, penicillin v, penicillin vk

• penicillins second generation (penicillinase-resistant penicillins)
  • cloxacillin, dicloxacillin, flucloxacillin, methicillin, nafcillin, oxacillin

• penicillins third generation (aminopenicillins)
  • amoxicillin, ampicillin, ampicillin-sulbactam, bacampicillin, pivampicillin
• see also amoxicillin-clavulanate

• penicillins fourth generation (extended-spectrum penicillins)
  • carbenicillin, mezlocillin, piperacillin, piperacillin-tazobactam, ticarcillin, ticarcillin-clavulanate

• Dailymed label info on Dicloxacillin
• FDA Dicloxacillin

Dicloxacillin Resources
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