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(ox-uh-SILL-in SO-dee-uhm)
Oxacillin Sodium
Powder for oral solution: 250 mg/5 mL
Powder for injection: 500 mg
Powder for injection: 1 g
Powder for injection: 2 g
Powder for injection: 10 g
Class: Antibiotic, Penicillin

 Action Inhibits mucopeptide synthesis in bacterial cell wall.

 Indications Treatment of infections caused by penicillinase-producing staphylococci; initial therapy of suspected staphylococcal infection.

 Contraindications Hypersensitivity to penicillins. Do not treat severe pneumonia, empyema, bacteremia, pericarditis, meningitis and purulent or septic arthritis with oral oxacillin during acute state.

 Route/Dosage

Adults: PO/IV/IM 250 mg to 1 g q 4 to 6 hr. Children (less than 40 kg): PO/IV/IM 50 to 100 mg/kg/day in divided doses q 4 to 6 hr. Premature/Neonates: IV/IM 25 mg/kg/day.

 Interactions

Contraceptives, oral: Reduced efficacy of oral contraceptives. Probenecid: Increased oxacillin levels. Tetracyclines: Impaired bactericidal effects of oxacillin. Aminoglycosides.

 Lab Test Interferences

Antiglobulin (Coombs’) test: Drug may cause false-positive results.

Urine and serum protein determinations: Drug may cause false-positive reactions with sulfosalicylic acid and boiling test, acetic acid test, biuret reaction, and nitric acid test but not with brompheol blue test (Multi-Stix).

Urine glucose test: May cause false-positive urine glucose test result with Benedict solution, Fehling solution, or Clinitest tablets but not with enzyme-based tests (eg, Clinistix, Tes-tape).

 Adverse Reactions

CNS: Neurotoxicity (eg, lethargy, neuromuscular irritability, hallucinations, convulsions and seizures); dizziness; fatigue; insomnia; reversible hyperactivity; prolonged muscle relaxation. DERMATOLOGIC: Ecchymosis. EENT: Itchy eyes; abnormal taste perception. GI: Glossitis; stomatitis; gastritis; sore mouth or tongue; dry mouth; furry tongue; black “hairy” tongue; nausea; anorexia; vomiting; abdominal pain or cramp; diarrhea or bloody diarrhea; rectal bleeding; flatulence; enterocolitis; pseudomembranous colitis; anorexia. GU: Interstitial nephritis (eg, oliguria, proteinuria, hematuria, hyaline casts, pyuria); nephropathy; increased creatinine and BUN; vaginitis. HEMATOLOGIC: Deep vein thrombosis; hematomas; phlebitis; anemias; thrombocytopenia; eosinophilia; leukopenia; granulocytopenia; neutropenia; bone marrow depression; agranulocytosis; reduced Hgb or Hct; prolongation of bleeding and prothrombin time. HEPATIC: Transient hepatitis; cholestatic jaundice; increased LFT results. METABOLIC: Elevated serum alkaline phosphatase, AST, ALT, bilirubin, and LDH; hypernatremia; hypokalemia; reduced albumin, total proteins, and uric acid. OTHER: Hypersensitivity reactions that may lead to death; hyperthermia; pain at site of injection; hyperthermia; sciatic neuritis.

 Precautions

Pregnancy: Category B. Lactation: Excreted in breast milk. Hypersensitivity: Reactions range from mild to life-threatening. Administer cautiously to cephalosporin-sensitive or imipenem-sensitive patients because of possible crossreactivity. Pseudomembranous colitis: Consider pseudomembranous colitis in patients who develop diarrhea. Sodium content: Contains 2.5 to 3.1 mEq sodium/g. Superinfection: May result in bacterial or fungal overgrowth of nonsusceptible organisms.

PATIENT CARE CONSIDERATIONS

 Administration/Storage

  • Administer at regular intervals around the clock.
  • Administer oral doses on empty stomach at least 1 hr before or 2 hr after meals.
  • Reconstitute IM preparation to dilution of 250 mg/1.5 mL. Use deep, slow injection. Rotate sites to prevent tissue irritation.
  • Reconstitute IV preparation with Sterile Water for Injection or Sodium Chloride for Injection. Administer slowly over approximately 10 min to prevent vein irritation.
  • IM solution is stable for up to 3 days at room temperature or 7 days under refrigeration.
  • IV solutions are stable for at least 6 hr at room temperature.
  • Reconstituted oral solution is stable for 14 days if refrigerated.

 Assessment/Interventions

  • Obtain patient history, including drug history and any known allergies.
  • Ensure that specimens for culture and sensitivity have been obtained before starting therapy.
  • Assess for infection at beginning and throughout course of therapy (eg, fever, appearance of wound, increased WBC).
  • Observe patient for signs and symptoms of anaphylaxis (eg, rash, pruritis, laryngeal edema, wheezing). Discontinue drug if these symptoms occur.
  • Keep resuscitation equipment, adrenaline, and antihistamines available.
  • Notify health care provider if unusual bleeding or bruising occurs.
OVERDOSAGE: SIGNS & SYMPTOMS
  Neuromuscular hyperexcitability, stupor, agitation, confusion, asterixis, hallucinations, coma, multifocal myoclonus, seizures, encephalopathy

 Patient/Family Education

  • Advise patient to complete full course of therapy, even if symptoms abate, to prevent reoccurrence of infection.
  • Instruct patient to discard any liquid forms of medication after 7 days if stored at room temperature; after 14 days if refrigerated.
  • Instruct patient to notify health care provider if symptoms of infection do not improve.
  • Advise patient to report puritus and rash immediately.
  • Instruct patient to report the following signs of superinfection:
    black, “furry” tongue, loose or foul-smelling stools, vaginal itching, discharge.

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