Neonatal Drug Therapy Manual

Cloxacillin

Disclaimer: Official controlled document is the CHEO and Ottawa Hospital online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Updated March 5, 2024 - 2:37pm

Alternate Name(s): 
Orbenin, Tegopen
Classification: 
Antibiotic (semi-synthetic penicillin)
Original Date: 
March 1993
Revised Date: 
September 2020
Indications: 
  • Treatment of infections caused by penicillinase-producing strains of Staphylococci
Administration: 
  • IV direct: over 5 - 10 minutes
  • IV intermittent infusion: over 15 - 30 minutes
Dosage: 

IV

< 2 kg:

  • 0 - 7 days: 25 mg/kg/dose Q12H
  • > 7 days: 25 mg/kg/dose Q8H

>  2 kg:

  • 0 - 7 days: 25 mg/kg/dose Q8H
  • > 7 days: 25 mg/kg/dose Q6H

 

For suspected meningitis, serious or invasive infections: 50 mg/kg/dose using appropriate dosing interval as above 

Side Effects: 
  • GI: diarrhea
  • Hematologic (rare): anemia, leukopenia, thrombocytopenia
  • Hepatic: elevated liver enzymes
  • Local: phlebitis
  • Renal: acute interstitial nephritis
Parameters to Monitor: 
  • CBC with differential
  • Liver function tests
  • BUN and serum creatinine
  • Injection site
Reconstitution and Stability: 

Cloxacillin 2 g vial

  • Add 18.7 mL SWFI
  • Take 4 mL (400 mg) and add to 16 mL D5W.
  • Final concentration: 20 mg/mL

 

Compatibility: 

- Solutions Compatible: dextrose, saline, dextrose-saline combinations

- Y-site Compatible: amino acids and dextrose, heparin, KCl (up to 60 mmol/L)

Incompatible: gentamicin, hydromorphone, lipids, pantoprazole, morphine

Notes: 

- In case of extravasation, hyaluronidase should be administered

References: 

- Cloxacillin CPhA monograph, Apr 23, 2020

- American Society on Health-System Pharmacists (ASHP). Handbook on Injectable Drugs 19th Edition. Bethesda: American Society of Health-System Pharmacists; 2017

 

 

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