Dicloxacillin

Dicloxacillin
Clinical data
AHFS/Drugs.com Monograph
MedlinePlus a685017
Pregnancy
category
  • AU: B2
  • US: B (No risk in non-human studies)
    Routes of
    administration
    Oral
    ATC code
    Legal status
    Legal status
    Pharmacokinetic data
    Bioavailability 60 to 80%
    Protein binding 98%
    Metabolism Hepatic
    Elimination half-life 0.7 hours
    Excretion Renal and biliary
    Identifiers
    CAS Number
    PubChem CID
    DrugBank
    ChemSpider
    UNII
    KEGG
    ChEBI
    ChEMBL
    ECHA InfoCard 100.019.535
    Chemical and physical data
    Formula C19H17Cl2N3O5S
    Molar mass 470.327 g/mol
    3D model (JSmol)
      (verify)

    Dicloxacillin is a narrow-spectrum β-lactam antibiotic of the penicillin class.[1] It is used to treat infections caused by susceptible (non-resistant) Gram-positive bacteria.[1] It is active against beta-lactamase-producing organisms such as Staphylococcus aureus, which would otherwise be resistant to most penicillins. Dicloxacillin is available under a variety of trade names including Diclocil (BMS).[2]

    Medical uses

    Dicloxacillin is used to treat mild-to-moderate staphylococcal infections.[3] 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.[3]

    Dicloxacillin is similar in pharmacokinetics, antibacterial activity, and indications to flucloxacillin, and the two agents are considered interchangeable.[4] It is believed to have lower incidence of severe hepatic adverse effects than flucloxacillin, but a higher incidence of renal adverse effects.[4]

    Dicloxacillin is used for the treatment of infections caused by susceptible bacteria. Specific approved indications include:[4]

    Available forms

    Dicloxacillin is commercially available as the sodium salt, dicloxacillin sodium, in capsules and as a powder for reconstitution.[1][5]

    Contraindications

    Dicloxacillin is contraindicated in those with a previous history of allergy (hypersensitivity/anaphylactic reaction) to any penicillins.[1][6]

    Adverse effects

    Common adverse drug reactions (ADRs) associated with the use of dicloxacillin include: diarrhoea, nausea, rash, urticaria, pain and inflammation at injection site, superinfection (including candidiasis), allergy, and transient increases in liver enzymes and bilirubin.[4]

    On rare occasions, cholestatic jaundice (also referred to as cholestatic hepatitis) has been associated with dicloxacillin therapy. The reaction may occur up to several weeks after treatment has stopped, and takes weeks to resolve. The estimated incidence is 1 in 15,000 exposures, and is more frequent in people over 55 years old, females, and those with treatment longer than 2 weeks.[4]

    It should be used with caution and monitored in the elderly, particularly with intravenous administration, due to a risk of thrombophlebitis.[1]

    Interactions

    Dicloxacillin has potential interactions with following drugs:

    Resistance

    Despite dicloxacillin being insensitive to beta-lactamases, some organisms have developed resistance to other narrow-spectrum β-lactam antibiotics including methicillin. Such organisms include methicillin-resistant Staphylococcus aureus (MRSA).[10]

    Mechanism of action

    Like other β-lactam antibiotics, dicloxacillin acts by inhibiting the synthesis of bacterial cell walls. It inhibits cross-linkage between the linear peptidoglycan polymer chains that make up a major component of the cell wall of Gram-positive bacteria.

    Medicinal chemistry

    Dicloxacillin is insensitive to beta-lactamase (also known as penicillinase) enzymes secreted by many penicillin-resistant bacteria. The presence of the isoxazolyl group on the side chain of the penicillin nucleus facilitates the β-lactamase resistance, since they are relatively intolerant of side-chain steric hindrance. Thus, it is able to bind to penicillin-binding proteins (PBPs) and inhibit peptidoglycan crosslinking, but is not bound by or inactivated by β-lactamase

    See also

    References

    1. 1 2 3 4 5 Product Information: DICLOXACILLIN SODIUM-dicloxacillin sodium capsule. Teva Pharmaceuticals USA Inc, Revised 8/2015
    2. Miranda-Novales, G; Leaños-Miranda, BE; Vilchis-Pérez, M; Solórzano-Santos, F (12 October 2006). "In vitro activity effects of combinations of cephalothin, dicloxacillin, imipenem, vancomycin and amikacin against methicillin-resistant Staphylococcus spp. strains". Annals of Clinical Microbiology and Antimicrobials. 5: 25. doi:10.1186/1476-0711-5-25. PMC 1617116. PMID 17034644.
    3. 1 2 "Dicloxacillin". livertox.nih.gov. Retrieved 2015-11-05.
    4. 1 2 3 4 5 Rossi S, editor. Australian Medicines Handbook 2006. Adelaide: Australian Medicines Handbook; 2006
    5. "Dicloxacillin: MedlinePlus Drug Information". www.nlm.nih.gov. Retrieved 2015-11-05.
    6. "DailyMed - DICLOXACILLIN SODIUM- dicloxacillin sodium capsule". dailymed.nlm.nih.gov. Retrieved 2015-11-05.
    7. Lacey, CS (May 2004). "Interaction of dicloxacillin with warfarin". The Annals of pharmacotherapy. 38 (5): 898. doi:10.1345/aph.1d484. PMID 15054148.
    8. Ronchera, CL; Hernández, T; Peris, JE; Torres, F; Granero, L; Jiménez, NV; Plá, JM (October 1993). "Pharmacokinetic interaction between high-dose methotrexate and amoxycillin". Therapeutic drug monitoring. 15 (5): 375–9. doi:10.1097/00007691-199310000-00004. PMID 8249043.
    9. Moellering RC, Jr (29 August 1983). "Rationale for use of antimicrobial combinations". The American Journal of Medicine. 75 (2A): 4–8. doi:10.1016/0002-9343(83)90088-8. PMID 6351605.
    10. Rosdahl, VT; Frimodt-Møller, N; Bentzon, MW (August 1989). "Resistance to dicloxacillin, methicillin and oxacillin in methicillin-susceptible and methicillin-resistant Staphylococcus aureus detected by dilution and diffusion methods". APMIS : acta pathologica, microbiologica, et immunologica Scandinavica. 97 (8): 715–22. PMID 2669854.
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