FLUCLOXACILLIN

Indications & Dose:

Skin e.g. furunculosis, carbuncle, abscess, impetigo - Soft and subcutaneous tissues e.g. cellulitis, lymphangitis Traumatic and surgical wounds, and of burns Bones e.g. arthritis, osteitis, osteomyelitis - External ear e.g. otitis externa - Lower respiratory tract e.g. pulmonary abscess, pneumonia, and bronchopneumonia

- Upper respiratory tract infections e.g. tonsillitis, sinusitis, pharyngitis Empyema (as part of a combination regimen) (in conjunction with drainage) - Meninges e.g. staphylococcal meningitis - Urinary and genital tract - Small intestine and colon. In addition parenteral flucloxacillin is indicated for treatment of endocarditis and septicaemia, particularly staphylococcal septicaemia. Flucloxacillin is indicated for prophylaxis in cardiovascular surgery (valve prostheses, artery prostheses) and in orthopedic surgery (arthroplasty, osteosynthesis and arthrotomy) because of the dominant pathogenic potential of staphylococci during such surgical procedures. Flucloxacillin is effective for the treatment of infections due to beta-haemolytic Streptococcus A such as sore throat and erysipelas, as well as infected burns; however, penicillin (G or V) constitutes the treatment of first choice. Flucloxacillin is not indicated for the prevention of rheumatic fever. 

 DOSAGE:

Orall: 250-500mg 6 hours, half to one hour before meals, children: less than 2 years quarter of the adult dose, 2-10 years, half of the adult dose.

Adults - Total daily dosage of 1 g to 3 g, administered in 3 - 4 divided doses, by i.v. or i.m. injection. - In cases of severe infections: Up to 8 g per day in 4 rapid infusions (20 - 30 minutes). - No single infusion should exceed 2 g. - Usage of up to 12 g per day for the treatment of bacterial endocarditis is well documented in the medical literature. - In surgical prophylaxis: 2 g intravenously (bolus or infusion) upon induction of anaesthesia, to be repeated every 6 hours for 24 hours in cases of vascular and orthopaedic surgery, and for 48 hours in cases of cardiac or coronary surgery.

Children - 25-50 mg / kg / day administered in 3 - 4 divided doses by i.m. or i.v. injection. - In cases of severe infections: Up to 100 mg / kg / day may be administered parenterally. - No single bolus injection or infusion should exceed 33 mg / kg.

Elderly No adjustment needed; as for adults, unless there is evidence of renal impairment (see below).

Renal Impairment The excretion of flucloxacillin is slowed in cases of renal failure. If creatinine clearance drops below 10 ml/min, then the recommended dosage is 1 g every 8 to 12 hours. (In anuric patients, the maximum dosage is 1 g every 12 hours). Neither haemodialysis nor peritoneal dialysis lowers the serum levels of flucloxacillin. Therefore, dialysis need not be accompanied by an additional dose.

Method of administration.

Parenteral Route: Flucloxacillin solutions containing lidocaine should not be used for intravenous administration.

Contraindications:

 Flucloxacillin is penicillin and should not be given to patients with a history of hypersensitivity to beta-lactam antibiotics (e.g. penicillins, cephalosporins) or excipients. Flucloxacillin is contra-indicated in patients with a previous history of flucloxacillin-associated jaundice/ hepatic dysfunction. Ocular administration.

Side Effects:

Cautions:

Precautions:

Hypersensitivity to cephalosporins, prolonged or repeated therapy 

Interaction:

Drugs

Tetracyclines: Possible inhibition of antibacterial activity of penicillins 

Warnings:

Adverse Effects:

Lactations:

Special Precautions:

Counselling:

Side Effects Or Adverse Reactions:

CNS: Anxiety, depression, fever, hallucinations, headache, twitching

GI: Abdominal pain, colitis, diarrhea; glossitis,

increased AST, ALT; nausea, vomiting

GU: Hematuria, vaginitis

HEMS: Bone marrow depression, eosinophilia, increased bleeding time

SKIN: Rash, urticaria 

Patient And Carer Advice: