[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)
