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Cloxacillin

Indication & Dosage Oral Staphylococcal infections resistant to benzylpenicillin Adult: 250-500 mg 4 times daily. Child: 50-100 mg/kg in divided doses every 6 hr. Incompatibility: Incompatible with aminoglycosides and a number of other antimicrobials. Administration Contraindications Special Precautions Adverse Drug Reactions Drug Interactions Should be taken on an empty stomach. (Take on an empty stomach 1 hr before or 2 hr after meals.) Hypersensitivity to penicillins. Renal impairment; pregnancy and lactation. Porphyria. Neutropenia, agranulocytosis; GI upsets; rash. Sore mouth or tongue. Black hairy tongue. Potentially Fatal: Neuromuscular hypersensitivity; pseudomembranous colitis; anaphylaxis. Co-admin of probenecid or disulfiram may result in higher cloxacillin concentration. Chloramphenicol and tetracycline antagonise bactericidal effect of penicillins. Potentially Fatal: Increased hypoprothrombinaemic effects of oral anticoagulants. Delayed absorption in the presence of food. Interferes with urinary glucose tests using cupric sulfate. False-positive results in urine and serum protein, uric acid and urinary steroid tests. Category B: Either animal-reproduction studies have not demonstrated a foetal risk but there are no controlled studies in pregnant women or animal-reproduction studies have shown an adverse effect (other than a decrease in fertility) that was not confirmed in controlled studies st in women in the 1 trimester (and there is no evidence of a risk in later trimesters). Cloxacillin is resistant to degradation by penicillinases. It is particularly useful against penicillinase-producing staphylococci. Highly active againstS aureus, S pyogenes, S viridans and S pneumoniae. Absorption: Incompletely absorbed from the GI tract with peak plasma concentrations after 1-2 hr (oral); may be reduced in the presence of food. Completely absorbed with peak plasma concentrations after 30 min (IM). Distribution: Pleural and synovial fluids and bone (therapeutic concentrations), CSF (small amounts except when the meninges are inflamed; crosses the placenta and enters the breast milk. Protein-binding: 94% Metabolism: Minimal metabolism. Excretion: Via the urine by glomerular filtration and renal tubular secretion (35% of an oral dose); via the bile (Up to 10%). Not removed by dialysis; 0.5-1 hr (elimination half-life).

Food Interaction Lab Interference Pregnancy Category (US FDA)

Mechanism of Action

Ampicillin

Indication & Dosage

Oral Biliary tract infections Adult: 250-500 mg every 6 hr. Child: 50-100 mg/kg daily, given in equally divided doses every 6 hr. Max: 2-4 g/day. Renal impairment: Patients undergoing haemodialysis should receive an additional dose after the session.

CrCl (ml/min) Dosage Recommendation <10 Dose reduction or increase in dose interval.

Oral Endocarditis Adult: 250-500 mg every 6 hr. Child: 50-100 mg/kg daily, given in equally divided doses every 6 hr. Max: 2-4 g/day. Renal impairment: Patients undergoing haemodialysis should receive an additional dose after the session.

CrCl (ml/min) Dosage Recommendation <10 Dose reduction or increase in dose interval.

Oral Otitis media Adult: 250-500 mg every 6 hr. Child: 50-100 mg/kg daily, given in equally divided doses every 6 hr. Max: 2-4 g/day. Renal impairment: Patients undergoing haemodialysis should receive an additional dose after the session.

CrCl (ml/min) Dosage Recommendation <10 Dose reduction or increase in dose interval.
Oral Peritonitis Adult: 250-500 mg every 6 hr. Child: 50-100 mg/kg daily, given in equally divided doses every 6 hr. Max: 2-4 g/day. Renal impairment: Patients undergoing haemodialysis should receive an additional dose after the session.

CrCl (ml/min) Dosage Recommendation <10 Dose reduction or increase in dose interval.

Oral Bronchitis Adult: 250-500 mg every 6 hr. Child: 50-100 mg/kg daily, given in equally divided doses every 6 hr. Max: 2-4 g/day. Renal impairment: Patients undergoing haemodialysis should receive an additional dose after the session.

CrCl (ml/min) Dosage Recommendation

<10

Dose reduction or increase in dose interval.

Oral Perinatal streptococcal infections Adult: 250-500 mg every 6 hr. Child: 50-100 mg/kg daily, given in equally divided doses every 6 hr. Max: 2-4 g/day. Renal impairment: Patients undergoing haemodialysis should receive an additional dose after the session.

CrCl (ml/min) Dosage Recommendation <10 Dose reduction or increase in dose interval.

Oral Gastroenteritis Adult: 250-500 mg every 6 hr. Child: 50-100 mg/kg daily, given in equally divided doses every 6 hr. Max: 2-4 g/day. Renal impairment: Patients undergoing haemodialysis should receive an additional dose after the session.

CrCl (ml/min) Dosage Recommendation <10 Dose reduction or increase in dose interval.

Oral Listeriosis Adult: 250-500 mg every 6 hr. Child: 50-100 mg/kg daily, given in equally divided doses every 6 hr. Max: 2-4 g/day. Renal impairment: Patients undergoing haemodialysis should receive an additional dose after the session.

CrCl (ml/min) Dosage Recommendation <10 Dose reduction or increase in dose interval.

Oral Susceptible infections Adult: 250-500 mg every 6 hr. Child: 50-100 mg/kg daily, given in equally divided doses every 6 hr. Max: 2-4 g/day. Renal impairment: Patients undergoing haemodialysis should receive an additional dose after the session.

CrCl (ml/min) Dosage Recommendation <10 Dose reduction or increase in dose interval.

Oral Typhoid and paratyphoid fever Adult: 1-2 g every 6 hr for 2 wk in acute infections and 4-12 wk in carriers. Renal impairment: Patients undergoing haemodialysis should receive an additional dose after the session. Oral Uncomplicated gonorrhoea Adult: 2 g with 1 g of probenecid as a single dose, recommended to be repeated in female patients.

Renal impairment: Patients undergoing haemodialysis should receive an additional dose after the session.

CrCl (ml/min) Dosage Recommendation <10 Dose reduction or increase in dose interval.
Intravenous Intrapartum prophylaxis against group B Streptoccocal infection in neonates Adult: Initially, 2 g via inj followed by 1 g every 4 hr until delivery. Renal impairment: Patients undergoing haemodialysis should receive an additional dose after the session.

CrCl (ml/min) Dosage Recommendation <10 Dose reduction or increase in dose interval.
Injection As supplement in systemic therapy for treatment of susceptible infections Adult: For intrapleural or intraperitoneal injections: 500 mg daily, dissolved in 5-10 ml of water. For intra-articular inj: 500 mg daily, dissolved in up to 5 ml of water or a solution of 0.5% procaine HCl. Child: the adult dose. Renal impairment: Patients undergoing haemodialysis should receive an additional dose after the session.

CrCl (ml/min) Dosage Recommendation <10 Dose reduction or increase in dose interval.
Parenteral Meningitis Adult: 150-200 mg/kg daily in equally divided doses every 3-4 hr. May initiate with IV admin followed by IM injections. Child: and infants: 150 mg/kg daily in divided doses. Neonates: <1 wk: 50 mg/kg every 12 hr; older neonates: 50 mg/kg every 8 hr. Max: 3 g/day. May initiate with IV admin followed by IM injections. Renal impairment: Patients undergoing haemodialysis should receive an additional dose after the session.

CrCl (ml/min) Dosage Recommendation <10 Dose reduction or increase in dose interval.
Intravenous Septicaemia Adult: 150-200 mg/kg daily. Initiate with IV admin for at least 3 days, then continue with IM inj every 3-4 hr. Continue treatment for at least 48-72 hr after the patient has become asymptomatic or when there is evidence of bacterial eradication. Recommended treatment duration for infections caused by group-A -haemolytic streptococci: At least 10-days to prevent occurrence of acute rheumatic fever or acute glomerulonephritis. Renal impairment: Patients undergoing haemodialysis should receive an additional dose after the session.

CrCl (ml/min) Dosage Recommendation <10 Dose reduction or increase in dose interval.

Parenteral Susceptible infections Adult: 250-500 mg every 6 hr, can be given via IM or slow IV inj over 3-5 minutes or infusion. Child: 100-400 mg/kg daily in divided doses every 6 hr. Max: 12 g daily. Dose can be given via IM or slow IV inj over 3-5 minutes or infusion. Renal impairment: Patients undergoing haemodialysis should receive an additional dose after the session.

CrCl (ml/min) Dosage Recommendation <10 Dose reduction or increase in dose interval.

Reconstitution: Reconstitute according to manufacturer's instructions. Incompatibility: Y-site incompatibility: Amphotericin B cholesteryl sulfate complex, ondansetron, sargramostim, verapamil, vinorelbine epinephrine, fluconazole, hydralazine, midazolam. Syringe incompatibility: Erythromycin lactobionate, gentamicin, lincomycin, metoclopramide, hydromorphone, kanamycin. Admixture incompatibility: Amikacin, hydralazine, prochlorperazine, chlorpromazine, dopamine, gentamicin. Administration Overdosage Contraindications Special Precautions Adverse Drug Reactions Should be taken on an empty stomach. (Take on an empty stomach 1 hr before or 2 hr after meals.) Discontinue medication, treat symptomatically, and institute supportive measures as required. Hypersensitivity; infectious mononucleosis. Renal failure; patients with lymphatic leukaemia or HIV infections; pregnancy and lactation. GI upset, nausea, vomiting, diarrhoea; blood dyscrasias; urticaria, exfoliative dermatitis, rash; fever, seizures; interstitial nephritis. Potentially Fatal: Anaphylactic shock; pseudomembranous colitis; neuromuscular hypersensitivity; electrolyte imbalance. Simultaneous use with oral contraceptives may lead to increased risk of breakthrough bleeding and reduced efficacy of the contraceptive. Skin rash increased with allopurinol. Probenecid increases blood levels. Synergism with -lactamase inhibitors, clavulanic acid or sulbactam, penicillinase-stable drugs eg, cloxacillin or flucloxacillin and aminoglycosides. Potentially Fatal: Increases disulfiram and anticoagulant effects. Click to view more ampicillin Drug Interactions Reduced absorption with food. Category B: Either animal-reproduction studies have not demonstrated a foetal risk but there are no controlled studies in pregnant women or animal-reproduction studies have shown an adverse effect (other than a decrease in fertility) that was not confirmed in controlled studies st in women in the 1 trimester (and there is no evidence of a risk in later trimesters). Injection: Store at 20-25C. For admin: Use freshly prepared solutions. IV and IM solutions should be used within 1 hr after preparation. Intravenous:Store at 20-25C. For admin: Use freshly prepared solutions. IV and IM solutions should be used within 1 hr after preparation. Oral: Store at 20-25C. Parenteral: Store at 20-25C. For admin: Use freshly prepared solutions. IV and IM solutions should be used within 1 hr after preparation. Ampicillin exerts bactericidal action on both gm+ve and gm-ve organisms. Its spectrum includes gm+ve organisms eg, S pneumoniae and otherStreptococci, L monocytogenes and

Drug Interactions

Food Interaction Pregnancy Category (US FDA)

Storage

Mechanism of Action

gm-ve bacteria eg, M catarrhalis, N gonorrhoea, N meningitidis, E coli, P mirabilis, Salmonella, Shigella, and H influenzae. Ampicillin exerts its action by inhibiting the synthesis of bacterial cell wall. Absorption: Relatively well absorbed from the GI tract with peak plasma concentrations after 1-2 hr (oral); may be altered in the presence of food. Distribution: Widely distributed into the ascitic, pleural and joint fluids (therapeutic concentrations), CSF (small amounts except when the meninges are inflamed), bile (high concentrations); crosses the placenta and enters the breast milk (small amounts). Proteinbinding: 20%. Metabolism: Converted to some extent to penicilloic acid; undergoes enterohepatic recycling. Excretion: Via the urine by glomerular filtration and tubular secretion; via the faeces. May be removed by haemodialysis.