Dosing & Uses
Dosage Forms & Strengths
infusion solution
- 1g/50mL
- 2g/50mL
powder for injection
- 1g
- 2g
- 10g
Staphylococcal Infections
Mild to moderate infections: 250-500 mg IV/IM q4-6hr
Severe infections: 1 g IV/IM q4-6hr
Acute/chronic osteomyelitis/staphylococci infections: 1.5-2 g IV q4-6hr
Renal Infection
CrCl < 10 mL/min: May consider adjusting to the lower range of the usually recommended dose depending on severity of infection
Dosage Forms & Strengths
infusion solution
- 1g/50mL
- 2g/50mL
powder for injection
- 1g
- 2g
- 10g
Susceptible Staph Infections in Infants & Children
Mild to moderate infections: 100-200 mg/kg/day IV/IM divided q6hr
Severe infections: 150-200 mg/kg/day IV/IM divided q6hr
Maximum 4g/day for mild to moderate infections
Maximum 12g/day for severe infections
Susceptible Staph Infections in Neonates
(<7 days old, <2 kg) OR (>7 days old, <1.2 kg): 50 mg/kg/day divided q12hr IV/IM
(<7 days old, >2 kg) OR (>7 days old, 1.2-2 kg): 75 mg/kg/day divided q8hr IV/IM
>7 days old, >2 kg: 100 mg/kg/day divided q6hr IV/IM
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (0)
Serious - Use Alternative (10)
- BCG vaccine live
oxacillin decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.
- cholera vaccine
oxacillin, cholera vaccine. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Avoid coadministration of cholera vaccine with systemic antibiotics since these agents may be active against the vaccine strain. Do not administer cholera vaccine to patients who have received oral or parenteral antibiotics within 14 days prior to vaccination.
- demeclocycline
demeclocycline decreases effects of oxacillin by pharmacodynamic antagonism. Avoid or Use Alternate Drug. bacteriostatic agents may inhibit the effects of bactericidal agentsba.
- doxycycline
doxycycline decreases effects of oxacillin by pharmacodynamic antagonism. Avoid or Use Alternate Drug. bacteriostatic agents may inhibit the effects of bactericidal agents.
- microbiota oral
oxacillin decreases effects of microbiota oral by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Microbiota oral contains bacterial spores. Antibacterial agents may decrease efficacy if coadministered. Complete antibiotic regimens 2-4 days before initiating microbiota oral. .
- minocycline
minocycline decreases effects of oxacillin by pharmacodynamic antagonism. Avoid or Use Alternate Drug. bacteriostatic agents may inhibit the effects of bactericidal agents.
- omadacycline
omadacycline decreases effects of oxacillin by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Tetracyclines may interfere with the bactericidal action of penicillins. Monitor for decreased therapeutic effects of penicillins if concomitantly used with a tetracycline.
- sarecycline
sarecycline decreases effects of oxacillin by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Tetracyclines may interfere with the bactericidal action of penicillins. Monitor for decreased therapeutic effects of penicillins if concomitantly used with a tetracycline.
- tetracycline
tetracycline decreases effects of oxacillin by pharmacodynamic antagonism. Avoid or Use Alternate Drug. bacteriostatic agents may inhibit the effects of bactericidal agents.
- typhoid vaccine live
oxacillin decreases effects of typhoid vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.
Monitor Closely (11)
- aspirin
oxacillin, aspirin. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.
oxacillin, aspirin. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor. - aspirin rectal
oxacillin, aspirin rectal. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.
oxacillin, aspirin rectal. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor. - aspirin/citric acid/sodium bicarbonate
oxacillin, aspirin/citric acid/sodium bicarbonate. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.
oxacillin, aspirin/citric acid/sodium bicarbonate. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor. - chloramphenicol
chloramphenicol decreases effects of oxacillin by pharmacodynamic antagonism. Use Caution/Monitor. Bacteriostatic agents may inhibit the effects of bactericidal agents.
- choline magnesium trisalicylate
oxacillin, choline magnesium trisalicylate. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.
oxacillin, choline magnesium trisalicylate. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor. - ibuprofen IV
oxacillin, ibuprofen IV. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.
oxacillin, ibuprofen IV. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor. - rose hips
oxacillin, rose hips. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.
- salicylates (non-asa)
oxacillin, salicylates (non-asa). Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.
- salsalate
oxacillin, salsalate. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.
- sodium picosulfate/magnesium oxide/anhydrous citric acid
oxacillin decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
- willow bark
oxacillin, willow bark. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.
Minor (8)
- azithromycin
azithromycin decreases effects of oxacillin by pharmacodynamic antagonism. Minor/Significance Unknown. bacteriostatic antibiotics may interfere with the bactericidal actions of penicillins.
- clarithromycin
clarithromycin decreases effects of oxacillin by pharmacodynamic antagonism. Minor/Significance Unknown. bacteriostatic agents may inhibit the effects of bactericidal agents.
- colestipol
colestipol decreases levels of oxacillin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.
- erythromycin base
erythromycin base decreases effects of oxacillin by pharmacodynamic antagonism. Minor/Significance Unknown. bacteriostatic agents may inhibit the effects of bactericidal agents.
- erythromycin ethylsuccinate
erythromycin ethylsuccinate decreases effects of oxacillin by pharmacodynamic antagonism. Minor/Significance Unknown. bacteriostatic agents may inhibit the effects of bactericidal agents.
- erythromycin lactobionate
erythromycin lactobionate decreases effects of oxacillin by pharmacodynamic antagonism. Minor/Significance Unknown. bacteriostatic agents may inhibit the effects of bactericidal agents.
- erythromycin stearate
erythromycin stearate decreases effects of oxacillin by pharmacodynamic antagonism. Minor/Significance Unknown. bacteriostatic agents may inhibit the effects of bactericidal agents.
- rifampin
rifampin decreases levels of oxacillin by increasing metabolism. Minor/Significance Unknown.
Adverse Effects
1-10%
Diarrhea
Nausea
Fever
Rash
<1%
Eosinophilia
Leukopenia
Neutropenia
Thrombocytopenia
Hepatotoxicity
Elevated AST
Acute interstitial nephritis
Serum sickness-like reaction
Warnings
Contraindications
Allergy to penicillins, cephalosporins, imipenem
Solutions containing dextrose may be contraindicated in patients with known allergy to corn or corn products
Cautions
Monitor neonates for renal impairment
Serious and occasionally fatal hypersensitivity (anaphylactic shock with collapse) reactions have occurred in patients receiving penicillin; although anaphylaxis is more frequent following parenteral administration, it has occurred in patients receiving oral penicillins
Whenever allergic reactions occur, penicillin should be withdrawn unless, in the opinion of the physician, the condition being treated is life-threatening and amenable only to penicillin therapy
The use of antibiotics may result in overgrowth of nonsusceptible organisms; if new infections due to bacteria or fungi occur, the drug should be discontinued and appropriate measures taken
When penicillin therapy is indicated, it should be initiated only after a comprehensive patient drug and allergy history obtained; if an allergic reaction occurs, the drug should be discontinued and the patient should receive supportive treatment, eg, artificial maintenance of ventilation, pressor amines, antihistamines, and corticosteroids
Individuals with a history of penicillin hypersensitivity may also experience allergic reactions when treated with a cephalosporin
Prescribing oxacillin Injection, USP 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
In the treatment of suspected staphylococcal infections, therapy should be changed to another active agent if culture tests fail to demonstrate presence of staphylococci
Periodic assessment of organ system function including renal, hepatic, and hematopoietic should be made during prolonged therapy with oxacillin
Blood cultures, white blood cells, and differential cell counts should be obtained prior to initiation of therapy and at least weekly during therapy with oxacillin
Periodic urinalysis, blood urea nitrogen, and creatinine determinations should be performed during therapy with oxacillin and dosage alterations should be considered if these values become elevated; if any impairment of renal function is suspected or known to exist, a reduction in the total dosage should be considered and blood levels monitored to avoid possible neurotoxic reactions
AST (SGOT) and ALT (SGPT) values should be obtained periodically during therapy to monitor for possible liver function abnormalities
Clostridioides difficile-associated diarrhea (CDAD)
- C. difficile produces toxins A and B which contribute to the development of CDAD; hypertoxin producing strains of C. difficile cause increased morbidity and mortality, asthese infections can be refractory to antimicrobial therapy and may require colectomy
- CDAD must be considered in all patients who present with diarrhea following antibiotics; CDAD has been reported to occur over two months after the administration of antibacterial agents
- Careful medical history is necessary; if CDAD suspected or confirmed, ongoing antibiotic use not directed against C. difficile may need to be discontinued
- Appropriate fluid and electrolyte management, protein supplementation, antibiotic treatment of C. difficile, and surgical evaluation should be instituted as indicated
Drug interaction overview
- Tetracycline, a bacteriostatic antibiotic, may antagonize bactericidal effect of penicillin and concurrent use of these drugs should be avoided
- Oxacillin blood levels may be prolonged by concurrent administration of probenecid which blocks renal tubular secretion of penicillins
Pregnancy & Lactation
Pregnancy
Reproduction studies performed in the mouse, rat, and rabbit revealed no evidence of impaired fertility or harm to the fetus due to penicillinase-resistant penicillins; human experience with the penicillins during pregnancy has not shown any positive evidence of adverse effects on the fetus
There are no adequate or well-controlled studies in pregnant women showing conclusively that harmful effects of these drugs on the fetus can be excluded
Because animal reproduction studies are not always predictive of human response, this drug should be used during pregnancy only if clearly needed
No long-term animal studies conducted with these drugs; studies on reproduction (nafcillin) in rats and rabbits reveal no fetal or maternal abnormalities before conception and continuously through weaning (one generation)
Lactation
Penicillins are excreted in human milk; caution should be exercised when penicillins are administered to a nursing woman
Pregnancy Categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available.Pharmacology
Mechanism of Action
Bactericidal antibiotic that inhibits cell wall synthesis by binding to one or more of the penicillin binding proteins. Used in the treatment of infections caused by penicillinase-producing staphylococci. May be used to initiate therapy when a staphylococcal infection is suspected.
Pharmacokinetics
Half-Life: 23-60 min (adults; prolonged in renal insufficiency); 0.9-1.8 hr (children)
Peak Plasma Time: 30-60 min
Protein binding: 94%
Distribution: Bile, synovial, pleural, peritoneal, pericardial fluids
Metabolism: Hepatic to active metabolites
Excretion: Urine and feces
Administration
IV Incompatibilities
Additive: amikacin(?), cytarabine
Syringe: caffeine
Y-site: Na bicarb, verapamil
Aminoglycosides & tetracyclines, but compatibility depends on several factors (eg, concentrations of the drugs, specific diluents used, resulting pH, temperature)
IV Compatibilities
Solution: compatible w/ most common solvents
Additive: Chloramphenicol Na succinate, dopamine, KCl, verapamil
Y-site (partial list): Acyclovir, diltiazem, fluconazole, heparin, hydromorphone, MgSO4, meperidine, morphine, KCl, vit B/C, zidovudine
IV/IM Preparation
IM Injection
- For IM injection, reconstitute by adding 5.7 or 11.4 mL of SWI to a vial containing 1 or 2 g of oxacillin, respectively, to provide solutions containing 167 mg of oxacillin per mL (250 mg/1.5 mL)
- Shake vials well
IV Injection
- For direct injection, prepare a solution containing approximately 100 mg/mL by adding 10 or 20 mL SWI, ½NS or NS to vials containing 1 or 2 g of oxacillin, respectively
Intermittent or Continuous IV Infusion
- For intermittent IV infusion, reconstitute vials containing 1 or 2 g as for direct IV injection & further dilute with a compatible IV solution to a concentration of 0.5-40 mg/mL
- Alternatively, reconstitute ADD-Vantage vials containing 1 or 2 g according to the mfr's directions
IV/IM Administration
Administer by IM injection or slow IV injection or infusion
IM: deep into a large muscle (eg, gluteus maximus) & care should be taken to avoid sciatic nerve injury
IV Injection: slowly over about 10 min
Intermittent or Continuous IV Infusion: injections should not be used in series connections with other plastic containers: could result in air embolism from residual air being drawn from primary container before administration of fluid from secondary container is complete
Storage
Oxacillin powder: store at controlled room temp
Oxacillin in dextrose injection: store <-20°C
Images
| BRAND | FORM. | UNIT PRICE | PILL IMAGE |
|---|---|---|---|
| oxacillin injection - | 10 gram vial |  | |
| oxacillin injection - | 2 gram vial |  | |
| oxacillin injection - | 1 gram vial |  | |
| oxacillin injection - | 2 gram vial |  | |
| oxacillin injection - | 1 gram vial |  | |
| oxacillin injection - | 10 gram vial |  | |
| oxacillin injection - | 10 gram vial |  | |
| oxacillin injection - | 2 gram vial |  | |
| oxacillin injection - | 10 gram vial |  | |
| oxacillin injection - | 2 gram vial |  | |
| oxacillin injection - | 1 gram vial |  | |
| oxacillin injection - | 2 gram vial |  | |
| oxacillin injection - | 10 gram vial |  | |
| oxacillin injection - | 1 gram vial |  | |
| oxacillin injection - | 1 gram vial |  |
Copyright © 2010 First DataBank, Inc.
Patient Handout
oxacillin injection
OXACILLIN - INJECTION
(OX-a-SIL-in)
USES: Oxacillin is used to treat a wide variety of bacterial infections. It is a penicillin antibiotic. It works by stopping the growth of bacteria.
HOW TO USE: This medication is given by injection into a vein or into a muscle as directed by your doctor, usually every 4 to 6 hours. The dosage is based on your medical condition and response to treatment. For children, the dosage is also based on weight.If you are using this medication at home, learn all preparation and usage instructions from your health care professional. Before using, check this product visually for particles or discoloration. If either is present, do not use the liquid. Learn how to store and discard medical supplies safely.If you are using the frozen pre-mixed solution, thaw the container at room temperature or in the refrigerator. If the bag is thawed in the refrigerator, let it sit at room temperature for at least 1 hour before using. Do not thaw by putting in warm/hot water or microwaving. After thawing, shake well and squeeze the container to check for leaks. Discard if the container leaks. Do not re-freeze the solution after thawing.For the best effect, use this antibiotic at evenly spaced times. To help you remember, use this medication at the same time(s) every day.Continue to use this medication for the full time prescribed, even if symptoms disappear after a few days. Stopping the medication too early may result in a return of the infection.Tell your doctor if your condition lasts or gets worse.
SIDE EFFECTS: Pain/redness/swelling at the injection site may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: easy bruising/bleeding, signs of a new infection (such as sore throat that doesn't go away, fever, chills), foamy/pink/bloody/dark urine, signs of kidney problems (such as a change in the amount of urine), swelling hands/ankles/feet, stomach/abdominal pain, nausea/vomiting that doesn't stop, unusual tiredness, yellowing eyes/skin, seizures, uncontrolled movements, mental/mood changes (such as confusion, hallucinations).This medication may rarely cause a severe intestinal condition due to a bacteria called C. difficile. This condition may occur during treatment or weeks to months after treatment has stopped. Tell your doctor right away if you develop: diarrhea that doesn't stop, abdominal or stomach pain/cramping, blood/mucus in your stool.If you have these symptoms, do not use anti-diarrhea or opioid products because they may make symptoms worse.Use of this medication for prolonged or repeated periods may result in oral thrush or a new yeast infection. Contact your doctor if you notice white patches in your mouth, a change in vaginal discharge, or other new symptoms.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
PRECAUTIONS: Before using oxacillin, tell your doctor or pharmacist if you are allergic to it; or to other antibiotics (such as penicillins, cephalosporins); or if you have any other allergies. This product may contain inactive ingredients (such as corn for products containing dextrose), which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: kidney disease, liver disease.This medication contains sodium. Consult your doctor or pharmacist if you are on a salt-restricted diet or if you have a condition that could be worsened by an increase in salt intake (such as heart failure, high blood pressure).Oxacillin may cause live bacterial vaccines (such as typhoid vaccine) to not work well. Tell your health care professional that you are using oxacillin before having any immunizations/vaccinations.Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).Older adults may be more sensitive to the extra sodium in this medication.During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.This drug passes into breast milk in small amounts. Consult your doctor before breast-feeding.
DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.One product that may interact with this drug is: methotrexate.This medication may interfere with certain lab tests (including certain urine protein tests), possibly causing false test results. Make sure lab personnel and all your doctors know you use this drug.
OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: seizures, mental/mood changes (such as agitation, confusion).
NOTES: Lab and/or medical tests (such as complete blood count, sodium/potassium blood levels, kidney/liver function tests) should be done while you are using this medication. Keep all medical and lab appointments.
MISSED DOSE: It is important to get each dose of this medication as scheduled. If you miss a dose, ask your doctor or pharmacist right away for a new dosing schedule. Do not double the dose to catch up.
STORAGE: Consult the product instructions or your pharmacist for storage details. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.
Information last revised October 2021. Copyright(c) 2023 First Databank, Inc.
IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.
Formulary
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