Flucloxacillin

Flucloxacillin

[1gm vial $1.41]

ADMINISTRATION ROUTES:

  • IV, IM, PO, NG

ALTERNATIVE NAMES:

  • Flucoxin, Staphlex, Flucloxacillin

ICU INDICATIONS:

  1. treatment of infections caused by susceptible organisms (particularly susceptible Staph aureus)

PRESENTATION AND ADMINISTRATION:

  • IV:
    250mg, 500mg and 1gm
    Add 5ml of Water for injection to 250mg, 500mg or 1gm vial. Shake gently until all the powder is dissolved. Withdraw contents and dilute contents with Water for Injection in the syringe to 10ml for the 250mg and 500mg vials or to 15-20ml for the 1gm vial.
    Compatible with the following IV fluids:
    Normal saline, Dextran solutions, 5% dextrose, Hartmanns, Glucose and sodium chloride
    Solutions prepared for direct IV injection should be prepared immediately before use.
    Store at room temperature
    Protect from light
  • IM:
    Not generally administered by this route in ICU
  • PO / NG:
    Flucloxacillin 500mg capsules (grey/caramel) Staphlex 250mg and 500mg capsules (black/yellow) Flucloxacillin oral suspension (white/pinkish)

    Note: absorption of oral doses is significantly reduced by food so NG administration is impractical in patients being fed NG

  • DOSAGE:
    IV:

    1-2gm 6 hourly
    PO:

    500mg 6 hourly

DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:

  • Dose in renal impairment [GFR (ml/min)]
    <10: dose as in normal renal function up to a total daily dose of 4g
    10-20: dose as in normal renal function up to a total daily dose of 4gm
    >20-50:dose as in normal renal function
  • Dose in renal replacement therapy
    CAPD: dose as in normal renal function up to a total daily dose of 4gm
    HD: dose as in normal renal function
    CVVHDF: dose as in normal renal function

DOSAGE IN PAEDIATRICS:

  • IV:
    In the 1st week of life use 50mg/kg 12 hourly; in the 2nd to 4th weeks of life use 50mg/kg 8 hourly otherwise 25-50mcg/kg IV 6 hourly
  • PO:
    12.5-25mg/kg 6 hourly

CLINICAL PHARMACOLOGY:

  • All penicillins inhibit the biosynthesis of the bacterial cell wall. Flucloxacillin is highly resistant to inactivation by staphylococcal penicillinase and is active against penicillinase-producing and non penicillinase-producing strains of Staphylococcus aureus.

CONTRAINDICATIONS:

  1. A history of allergic reaction to any of the penicillins is a contraindication.

WARNINGS

  • Anaphylaxis
    Penicillins are a common cause of anaphylactic reactions
  • Pseudomembranous colitis
    Pseudomembranous colitis has been reported with nearly all antibacterial agents, including flucloxacillin, and may range in severity from mild to life-threatening. Therefore, it is important to consider this diagnosis in patients who present with diarrhoea subsequent to the administration of antibacterial agents.

PRECAUTIONS

  • General:
    Prescribing Flucloxacillin 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.
  • Laboratory Tests:
    No tests in addition to routine ICU tests are required.
  • Drug/Laboratory Test Interactions:
    None noted.

IMPORTANT DRUG INTERACTIONS FOR THE ICU

  • Tetracycline, a bacteriostatic antibiotic, may antagonize the bactericidal effect of penicillin and concurrent use of these drugs should be avoided.

ADVERSE REACTIONS

  • Body as a Whole:
    Serum sickness like reactions, Anaphylaxis
  • Digestive System:
    Nausea, vomiting, diarrhea, and hemorrhagic/pseudomembranous colitis. Hepatic dysfunction including cholestatic jaundice, hepatic cholestasis and acute cytolytic hepatitis have been reported.
    Nervous System:

    Reversible hyperactivity, agitation, anxiety, insomnia, confusion, convulsions, behavioral changes, and/or dizziness have been reported rarely. Skin: Stevens-Johnson Syndrome, exfoliative dermatitus, toxic epidermal necrolysis, acute generalized exanthematous pustulosis, hypersensitivity vasculitis and urticaria have been reported
  • Haematological System:
    Anaemia, including hemolytic anaemia, thrombocytopenia, thrombocytopenic purpura, eosinophilia, leukopenia, and agranulocytosis have been reported during therapy with penicillins.

Critical Care Drug Manual

Print Friendly