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Vial $1.14, Capsule $0.11, Oral Liquid Bottle $3.73

Flucloxacillin

Editor: Updated Class:

ADMINISTRATION ROUTES:

IV, IM, PO, NG

ALTERNATIVE NAMES:

Flucoxin, Staphlex, Flucloxacillin

ICU INDICATIONS:

  1. Treatment of infections caused by susceptible organisms (particularly susceptible Staphylococcus aureus)

PRESENTATION AND ADMINISTRATION:

IV:

250 mg, 500 mg and 1 gm

Add 5 mL of Water for injection to 250 mg, 500 mg or 1 gm vial. Shake gently until all the powder is dissolved. Withdraw contents and dilute contents with Water for Injection in the syringe to 10 mL for the 250 mg and 500 mg vials or to 15-20 mL for the 1 gm 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 500 mg capsules (grey/caramel)

Staphlex 250 mg and 500 mg 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:

1-2 gm QID

PO:

500 mg QID

DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:

Dose in renal impairment

GFR (ml/min) DOSE
<10 dose as in normal renal function up to a total daily dose of 4 gm
10-20 dose as in normal renal function
>20-50 dose as in normal renal function

Dose in renal replacement therapy

MODALITY DOSE
CAPD dose as in normal renal function up to a total daily dose of 4 gm
HD dose as in normal renal function up to a total daily dose of 4 gm
CVVHDF dose as in normal renal function

DOSAGE IN PAEDIATRICS:

IV:

One week old: 50 mg/kg BD

2-4 weeks old: 50 mg/kg TDS

Over 1 month old: 25-50 mcg/kg IV QID

PO:

12.5-25 mg/kg QID

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

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. 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 IN ICU:

Tetracycline, a bacteriostatic antibiotic, may antagonise 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, diarrhoea, and haemorrhagic/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, behavioural changes, and/or dizziness have been reported rarely

Skin:

Stevens-Johnson Syndrome, exfoliative dermatitis, toxic epidermal necrolysis, acute generalised exanthematous pustulosis, hypersensitivity vasculitis and urticaria have been reported

Haematological System:

Anaemia, including haemolytic anaemia, thrombocytopaenia, thrombocytopaenic purpura, eosinophilia, leukopaenia, and agranulocytosis have been reported during therapy with penicillins