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Dicloxacillin

[Dicloxacillin photo]

KEY POINTS

  • Dicloxacillin is one of the penicillinase-resistant penicillins, which are also sometimes referred to as anti-Staphylococcal penicillins
    • Penicillins work by binding to penicillin binding proteins (PBPs) in susceptible bacteria, which interferes with bacterial cell wall synthesis
    • These drugs are sometimes referred to as the “C-O-N-D-O-M” drugs
      • CONDOM = cloxacillin, oxacillin, nafcillin, dicloxacillin, oxacillin (again), methicillin
      • This term is not advisable to use in practice, but can be helpful for studying purposes
  • Dicloxacillin and cloxacillin are the oral drugs in this class, while oxacillin and nafcillin are the injectable drugs in this class
  • The anti-staphylococcal penicillins have good activity versus methicillin-sensitive Staphylococcus aureus (MSSA) and some Streptococci activity as well
    • They lack any noteworthy anaerobic or Gram negative activity
    • Are infrequently used for bacteria other than MSSA
  • Dicloxacillin is typically dosed 4 times per day, which can mean reduced compliance and this is the major reason dicloxacillin is not frequently used in clinical practice
    • No dose adjustment for renal or hepatic impairment
    • Best to administer 1 hour before or 2 hours after a meal
  • Few drug-drug interactions
  • Well tolerated, with gastrointestinal side effects being the most common
  • Pregnancy category B

RESOURCES

  • Dicloxacillin Package Insert
  • IDSA Practice Guidelines (skin and soft tissue infection, prosthetic joint infection, diabetic foot infection)
  • The Penicillins (Mayo Clinic Proceedings, 1999)

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