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SERIOUS AND OCCASIONALLY FATAL HYPERSENSITIVITY (ANAPHYLACTIC SHOCK WITH COLLAPSE) REACTIONS HAVE OCCURRED IN PATIENTS RECEIVING PENICILLIN. THE INCIDENCE OF ANAPHYLACTIC SHOCK IN ALL PENICILLIN-TREATED PATIENTS IS BETWEEN 0.015 AND 0.04 PERCENT. ANAPHYLACTIC SHOCK RESULTING IN DEATH HAS OCCURRED IN APPROXIMATELY 0.002 PERCENT OF THE PATIENTS TREATED. ALTHOUGH ANAPHYLAXIS IS MORE FREQUENT FOLLOWING PARENTERAL ADMINISTRATION, IT HAS OCCURRED IN PATIENTS RECEIVING ORAL PENICILLINS.
WHEN PENICILLIN THERAPY IS INDICATED, IT SHOULD BE INITIATED ONLY AFTER A COMPREHENSIVE PATIENT DRUG AND ALLERGY HISTORY HAS BEEN OBTAINED. IF AN ALLERGIC REACTION OCCURS, THE DRUG SHOULD BE DISCONTINUED AND THE PATIENT SHOULD RECEIVE SUPPORTIVE TREATMENT, E.G., 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.
Clostridium difficile associated diarrhea (CDAD) has been reported with use of nearly all antibacterial agents, including Oxacillin (oxacillin (oxacillin for injection) for injection) Injection, USP, and may range in severity from mild diarrhea to fatal colitis. Treatment with antibacterial agents alters the normal flora of the colon leading to overgrowth of C. difficile.
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, as these infections can be refractory to antimicrobial therapy and may require colectomy. CDAD must be considered in all patients who present with diarrhea following antibiotic use. Careful medical history is necessary since CDAD has been reported to occur over two months after the administration of antibacterial agents.
If CDAD is 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 clinically indicated.
Oxacillin (oxacillin (oxacillin for injection) for injection) should generally not be administered to patients with a history of sensitivity to any penicillin. Penicillin should be used with caution in individuals with histories of significant allergies and/or asthma. 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.
Prescribing Oxacillin (oxacillin (oxacillin for injection) for injection) 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.
Bacteriologic studies to determine the causative organisms and their susceptibility to oxacillin should be performed. (See CLINICAL PHARMACOLOGY - Microbiology). In the treatment of suspected staphylococcal infections, therapy should be changed to another active agent if culture tests fail to demonstrate the presence of staphylococci.
Blood cultures, white blood cell, and differential cell counts should be obtained prior to initiation of therapy and at least weekly during therapy with oxacillin (oxacillin (oxacillin for injection) for injection) .
Periodic urinalysis, blood urea nitrogen, and creatinine determinations should be performed during therapy with oxacillin (oxacillin (oxacillin for injection) for injection) 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.
Carcinogenesis and Mutagenesis and Impairment of Fertility
No long-term animal studies have been 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).
Pregnancy Category B
Reproduction studies performed in the mouse, rat, and rabbit have revealed no evidence of impaired fertility or harm to the fetus due to the penicillinase-resistant penicillins. Human experience with the penicillins during pregnancy has not shown any positive evidence of adverse effects on the fetus. There are, however, 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.
Penicillins are excreted in human milk. Caution should be exercised when penicillins are administered to a nursing woman.
Because of incompletely developed renal function in pediatric patients, oxacillin (oxacillin (oxacillin for injection) for injection) may not be completely excreted, with abnormally high blood levels resulting. Frequent blood levels are advisable in this group with dosage adjustments when necessary. All pediatric patients treated with penicillins should be monitored closely for clinical and laboratory evidence of toxic or adverse effects. Safety and effectiveness in pediatric patients have not been established.
The potential for toxic effects in pediatric patients from chemicals that may leach from the single dose premixed intravenous preparation in plastic containers has not been evaluated.
Clinical studies of Oxacillin (oxacillin (oxacillin for injection) for injection) injection did not include sufficient number of subjects aged 65 and over to determine whether they respond differently from younger subjects. Other reported clinical experience has not identified differences in responses between the elderly and younger patients. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy.
This drug is known to be substantially excreted by the kidney, and the risk of toxic reactions to this drug may be greater in patients with impaired renal function. Because elderly patients are more likely to have decreased renal function, care should be taken in dose selection, and it may be useful to monitor renal function.
Oxacillin (oxacillin (oxacillin for injection) for injection) Injection contains 92.4 mg (4.02 mEq) of sodium per gram. At the usual recommended doses, patients would receive between 92.4 and 554 mg/day (4.02 and 24.1 mEq) of sodium. The geriatric population may respond with a blunted natriuresis to salt loading. This may be clinically important with regard to such diseases as congestive heart failure.
Last reviewed on RxList: 8/26/2008
This monograph has been modified to include the generic and brand name in many instances.
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