ﺑﺎﺯﮔﺸﺖ ﺑﻪ ﺻﻔﺤﻪ ﻗﺒﻠﯽ
خرید پکیج
تعداد آیتم قابل مشاهده باقیمانده : -45 مورد

Cloxacillin (United States: Not available): Pediatric drug information

Cloxacillin (United States: Not available): Pediatric drug information
2025© UpToDate, Inc. and its affiliates and/or licensors. All Rights Reserved.
For additional information see "Cloxacillin (United States: Not available): Drug information" and "Cloxacillin (United States: Not available): Patient drug information"

For abbreviations, symbols, and age group definitions show table
Brand Names: Canada
  • JAMP-Cloxacillin;
  • TEVA-Cloxacillin
Therapeutic Category
  • Antibiotic, Penicillin
Dosing: Neonatal

Dosage guidance:

Dosage form information: Not available in the United States.

General dosing:

Weight-directed dosing (Ref): Limited data available:

Preterm and term neonates: IV:

Note: Use the higher end of the dosing range for meningitis (Ref).

Cloxacillin Weight-Directed Neonatal Dosing

Body weight

Postnatal age

Dose

<2 kg

≤7 days

25 to 50 mg/kg/dose every 12 hours

8 to 28 days

25 to 50 mg/kg/dose every 8 hours

≥2 kg

≤7 days

25 to 50 mg/kg/dose every 8 hours

8 to 28 days

25 to 50 mg/kg/dose every 6 hours

Age-directed dosing (Ref): Limited data available:

Preterm and term neonates: IV:

Cloxacillin Age-Directed Neonatal Dosing

Postnatal age

Dose

<7 days

25 to 50 mg/kg/dose every 12 hours

7 to <21 days

25 to 50 mg/kg/dose every 8 hours

21 to 28 days

25 to 50 mg/kg/dose every 6 to 8 hours

Dosing: Pediatric

Dosage guidance:

Dosage form information: Not available in the United States.

General dosing:

Note: Doses are presented in mg/kg or fixed mg doses depending on weight; use caution. Duration depends on patient-specific factors including site of infection and clinical response.

Oral: Children and Adolescents (Ref):

5 to <40 kg: Oral: 50 mg/kg/day in divided doses every 6 hours.

≥40 kg: Oral: 250 to 500 mg every 6 hours. For very severe infections, higher doses may be required; maximum daily dose: 6,000 mg/day.

Parenteral: Infants, Children, and Adolescents: IV, IM: 100 to 200 mg/kg/day in divided doses every 6 hours (Ref); maximum dose: 2,000 mg/dose (Ref).

Endocarditis

Endocarditis (methicillin-susceptible Staphylococcus aureus): Children and Adolescents: IV: 200 to 300 mg/kg/day divided every 4 to 6 hours (Ref); maximum dose: 2,000 mg/dose (Ref). Recommended treatment duration is 4 to 6 weeks for native valve endocarditis and ≥6 weeks (as part of an appropriate combination regimen) for prosthetic valve endocarditis (Ref).

Osteoarticular infection, acute

Osteoarticular infection, acute (eg, bacterial arthritis, osteomyelitis):

IV: Children and Adolescents: IV: 100 to 200 mg/kg/day in divided doses every 4 to 6 hours (Ref); maximum dose: 2,000 mg/dose (Ref); maximum daily dose: 12,000 mg/day (Ref). May transition to oral therapy as appropriate (eg, following initial response to parenteral therapy, tolerating oral intake) (Ref).

Oral step-down therapy: Children and Adolescents: Oral: 100 mg/kg/day in divided doses every 6 hours; maximum dose: 1,000 mg/dose (Ref).

Duration of therapy: Minimum total duration is 10 to 14 days for bacterial arthritis and 21 to 28 days for osteomyelitis; however, duration may be longer and should be individualized based on several factors, including causative pathogen, response to therapy, and normalization of inflammatory markers (Ref).

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling.

Dosing: Liver Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer’s labeling.

Dosing: Adult

(For additional information see "Cloxacillin (United States: Not available): Drug information")

Note: Dose and duration of therapy can vary depending on infecting organism, severity of infection, and clinical response of patient. Treat severe staphylococcal infections for at least 14 days; endocarditis and osteomyelitis require an extended duration of therapy for 4 to 6 weeks. The intravenous route should be used for severe infections.

Usual dosage range:

Oral: 250 to 500 mg every 6 hours; may increase dose for serious infections (maximum dose: 6 g/day).

IM, IV: 1 to 2 g every 4 to 6 hours (Ref).

Bloodstream infection due to methicillin-susceptible Staphylococcus aureus

Bloodstream infection due to methicillin-susceptible Staphylococcus aureus: IV: 2 g every 4 to 6 hours (Ref); treat uncomplicated S. aureus bacteremia for ≥14 days starting from day of first negative blood culture, with longer courses warranted for endocarditis or metastatic sites of infection (Ref).

Endocarditis due to methicillin-susceptible staphylococci

Endocarditis due to methicillin-susceptible staphylococci:

Native valve: IV: 12 g/day in 4 to 6 divided doses for 4 to 6 weeks (Ref).

Prosthetic valve: IV: 12 g/day in 4 to 6 divided doses for ≥6 weeks, in combination with rifampin and gentamicin (Ref).

Osteomyelitis due to methicillin-susceptible Staphylococcus aureus

Osteomyelitis due to methicillin-susceptible Staphylococcus aureus: IV: 2 g every 4 hours for ≥6 weeks (Ref).

Skin and soft tissue infection

Skin and soft tissue infection:

Localized purulent skin lesions, impetigo: Oral: 250 to 500 mg every 6 hours for 5 to 7 days (Ref).

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Adult

The renal dosing recommendations are based upon the best available evidence and clinical expertise. Senior Editorial Team: Bruce Mueller, PharmD, FCCP, FASN, FNKF; Jason A. Roberts, PhD, BPharm (Hons), B App Sc, FSHP, FISAC; Michael Heung, MD, MS.

Kidney impairment prior to treatment initiation:

Altered kidney function:

Oral: No dosage adjustment necessary.

IV:

CrCl ≥10 mL/minute: No dosage adjustment necessary.

CrCl <10 mL/minute: No specific dosage adjustment recommended; however, monitor patients closely as studies conducted in critically ill patients with severe kidney impairment have found supratherapeutic cloxacillin concentrations (eg, >100 mg/L) in this population as well as neurotoxicity and nephrotoxicity (Ref). When treating less severe infections, consider limiting dose to 8 g/day (Ref).

Hemodialysis, intermittent (thrice weekly): Not significantly dialyzed (Ref):

Oral, IV: Dose as per CrCl <10 mL/minute (Ref).

Peritoneal dialysis: Unlikely to be significantly dialyzed (highly protein bound) (Ref):

Oral, IV: Dose as per CrCl <10 mL/minute (Ref).

CRRT:

Note: Drug clearance is dependent on the effluent flow rate, filter type, and method of renal replacement. Recommendations are based on high-flux dialyzers and effluent flow rates of 20 to 25 mL/kg/hour (or ~1,500 to 3,000 mL/hour) and minimal residual kidney function unless otherwise noted. Appropriate dosing requires consideration of adequate drug concentrations (eg, site of infection). Close monitoring of response and adverse reactions (eg, neurotoxicity) due to drug accumulation is important.

Oral, IV: No dosage adjustment necessary (Ref).

PIRRT (eg, sustained, low-efficiency diafiltration):

Note: Drug clearance is dependent on the effluent flow rate, filter type, and method of renal replacement. Appropriate dosing requires consideration of adequate drug concentrations (eg, site of infection). Close monitoring of response and adverse reactions (eg, neurotoxicity) due to drug accumulation is important.

Oral, IV: No dosage adjustment necessary (Ref).

Nephrotoxicity during treatment: Nephrotoxicity has been reported with cloxacillin use, particularly in patients receiving high-dose IV therapy (eg, ≥8 g per day). Risk factors include older age (eg, >75 years of age) and concomitant use of other nephrotoxins. If acute kidney injury occurs, discontinue cloxacillin and administer an alternate antibiotic (Ref).

Dosing: Liver Impairment: Adult

There are no dosage adjustments provided in the manufacturer’s labeling.

Adverse Reactions

The following adverse drug reactions are derived from product labeling unless otherwise specified. Reactions listed are based on reports for other agents in this same pharmacologic class and may not be specifically reported for cloxacillin.

Postmarketing:

Cardiovascular: Thrombophlebitis (IV)

Dermatologic: Acute generalized exanthematous pustulosis (Choon 2018), erythematous maculopapular rash (Moreno-Ancillo 2003)

Endocrine & metabolic: Hypokalemia (Nagasayi 2017)

Gastrointestinal: Clostridioides difficile colitis, diarrhea, epigastric discomfort, esophagitis (Zezos 2016), flatulence, hairy tongue, loose stools, nausea, stomatitis, vomiting (St John 1981)

Genitourinary: Hematuria (St John 1981)

Hematologic & oncologic: Agranulocytosis (Mani 2017), anemia, eosinophilia (Jayaweera 2018), granulocytopenia, hemolytic anemia, immune thrombocytopenia, leukopenia (St John 1981), neutropenia (Jayaweera 2018), thrombocytopenia

Hepatic: Cholestatic hepatitis (Goland 1998), cholestatic jaundice (Enat 1980), hepatic disease (vanishing bile duct syndrome) (Faragalia 2022), hepatotoxicity, increased serum alkaline phosphatase, increased serum transaminases (including increased serum alanine aminotransferase and increased serum aspartate aminotransferase) (St. John 1981)

Hypersensitivity: Anaphylaxis, angioedema, hypersensitivity angiitis (Garcia-Porrua 1999), hypersensitivity reaction (Rodriguez-Jimenez 2009), type IV hypersensitivity reaction (Moreno-Ancillo 2003)

Renal: Interstitial nephritis (Grimm 1989) renal tubular disease

Miscellaneous: Fever

Contraindications

Hypersensitivity to cloxacillin, other penicillins, cephalosporins, or any component of the formulation

Warnings/Precautions

Concerns related to adverse effects:

• Anaphylactoid/hypersensitivity reactions: Serious and occasionally severe or fatal hypersensitivity (anaphylactoid) reactions have been reported in patients on penicillin therapy, especially with a history of beta-lactam hypersensitivity, history of sensitivity to multiple allergens, or previous IgE-mediated reactions (eg, anaphylaxis, angioedema, urticaria). Use with caution in asthmatic patients.

• CNS effects: Although not reported with cloxacillin, the transport of penicillins across the blood-brain barrier may be enhanced by inflamed meninges or during cardiopulmonary bypass. An increased risk of myoclonia, seizures, or reduced consciousness may be observed in these patients (particularly those with renal failure).

• Hematologic effects: Penicillin use has been associated with hematologic disorders (eg, agranulocytosis, neutropenia, thrombocytopenia) believed to be a hypersensitivity phenomena. Reactions are most often reversible upon discontinuing therapy.

• Superinfection: Prolonged use may result in fungal or bacterial superinfection, including C. difficile-associated diarrhea (CDAD) and pseudomembranous colitis; CDAD has been observed >2 months postantibiotic treatment.

Disease-related concerns:

• Renal impairment: Use with caution in patients with renal impairment; rate of elimination is reduced.

• Seizure disorders: Use with caution in patients with a history of seizure disorder; high serum levels, particularly in the presence of renal impairment, may increase risk for seizures.

Special populations:

• Neonates: May have decreased renal clearance of cloxacillin; frequent evaluation of serum levels and of clinical status for adverse effects as well as frequent dosage adjustments may be necessary in this patient population.

Product Availability

Not available in the US

Generic Equivalent Available: US

Yes

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Capsule, Oral:

Generic: 250 mg, 500 mg

Solution Reconstituted, Injection:

Generic: 500 mg (1 ea); 1 g (1 ea); 2 g (1 ea); 10 g (1 ea)

Suspension Reconstituted, Oral:

Generic: 125 mg/5 mL (60 mL, 100 mL, 200 mL)

Administration: Pediatric

Oral: Administer 1 to 2 hours before meals.

Oral solution: Shake well. Administer liquid with an accurate measuring device; do not use a household teaspoon (under- or overdosage may occur).

Parenteral:

IM: Administer in appropriate anatomical site for age.

IV push: Administer slowly over 2 to 4 minutes.

IV infusion: Administer over 30 to 60 minutes (Ref).

Administration: Adult

Oral: Administer with water 1 hour before or 2 hours after meals.

IV:

IV push: Administer slowly over 2 to 4 minutes.

IV infusion: Administer over 30 to 40 minutes.

Storage/Stability

Capsule: Store at room temperature not exceeding 25°C (77°F).

Powder for injection: Store at controlled room temperature 15°C to 30°C (59°F to 86°F). Upon reconstitution the resulting solution is stable for up to 24 hours at controlled room temperature not exceeding 25°C (77°F) or up to 48 hours under refrigeration 2°C to 8°C (36°F to 46°F).

IV infusion: Note: After reconstitution of powder with appropriate volume of sterile water for injection, the manufacturer suggests further dilution to concentrations of 1 to 2 mg/mL in a compatible solution (eg, D5W, NS); solutions are stable for up to 12 hours at controlled room temperature.

Powder for oral solution: Prior to mixing, store powder at room temperature not exceeding 25°C (77°F). Refrigerate oral solution after reconstitution; discard after 14 days.

Use

Note: Not approved in the United States.

Canadian labeling: Treatment of streptococcal and staphylococcal infections (indicated in children and adults).

Metabolism/Transport Effects

Substrate of OAT1/3;

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program

Acemetacin: May increase serum concentration of Penicillins. Risk C: Monitor

Aminoglycosides: Penicillins may decrease serum concentration of Aminoglycosides. Primarily associated with extended spectrum penicillins, and patients with renal dysfunction. Risk C: Monitor

Bacillus clausii: Antibiotics may decrease therapeutic effects of Bacillus clausii. Management: Bacillus clausii should be taken in between antibiotic doses during concomitant therapy. Risk D: Consider Therapy Modification

BCG (Intravesical): Antibiotics may decrease therapeutic effects of BCG (Intravesical). Risk X: Avoid

BCG Vaccine (Immunization): Antibiotics may decrease therapeutic effects of BCG Vaccine (Immunization). Risk C: Monitor

Cholera Vaccine: Antibiotics may decrease therapeutic effects of Cholera Vaccine. Management: Avoid cholera vaccine in patients receiving systemic antibiotics, and within 14 days following the use of oral or parenteral antibiotics. Risk X: Avoid

Dichlorphenamide: Penicillins may increase hypokalemic effects of Dichlorphenamide. Risk C: Monitor

Fecal Microbiota (Live) (Oral): May decrease therapeutic effects of Antibiotics. Risk X: Avoid

Fecal Microbiota (Live) (Rectal): Antibiotics may decrease therapeutic effects of Fecal Microbiota (Live) (Rectal). Risk X: Avoid

Immune Checkpoint Inhibitors (Anti-PD-1, -PD-L1, and -CTLA4 Therapies): Antibiotics may decrease therapeutic effects of Immune Checkpoint Inhibitors (Anti-PD-1, -PD-L1, and -CTLA4 Therapies). Risk C: Monitor

Lactobacillus and Estriol: Antibiotics may decrease therapeutic effects of Lactobacillus and Estriol. Risk C: Monitor

Methotrexate: Penicillins may increase serum concentration of Methotrexate. Risk C: Monitor

Mycophenolate: Antibiotics may decrease active metabolite exposure of Mycophenolate. Specifically, concentrations of mycophenolic acid (MPA) may be reduced. Risk C: Monitor

Probenecid: May increase serum concentration of Penicillins. Risk C: Monitor

Sodium Benzoate: Penicillins may decrease therapeutic effects of Sodium Benzoate. Risk C: Monitor

Sodium Picosulfate: Antibiotics may decrease therapeutic effects of Sodium Picosulfate. Management: Consider using an alternative product for bowel cleansing prior to a colonoscopy in patients who have recently used or are concurrently using an antibiotic. Risk D: Consider Therapy Modification

Tetracyclines: May decrease therapeutic effects of Penicillins. Risk C: Monitor

Typhoid Vaccine: Antibiotics may decrease therapeutic effects of Typhoid Vaccine. Only the live attenuated Ty21a strain is affected. Management: Avoid use of live attenuated typhoid vaccine (Ty21a) in patients being treated with systemic antibacterial agents. Postpone vaccination until 3 days after cessation of antibiotics and avoid starting antibiotics within 3 days of last vaccine dose. Risk D: Consider Therapy Modification

Vancomycin: Cloxacillin may increase nephrotoxic effects of Vancomycin. Risk C: Monitor

Vitamin K Antagonists: Cloxacillin may decrease anticoagulant effects of Vitamin K Antagonists. Cloxacillin may increase anticoagulant effects of Vitamin K Antagonists. Risk C: Monitor

Food Interactions

Food decreases cloxacillin absorption; serum levels are reduced by ~50%. Management: Administer with water on an empty stomach 1 hour before or 2 hours after meals.

Pregnancy Considerations

Penicillin class antibiotics cross the placenta in varying degrees. Cloxacillin is highly protein bound which may influence fetal exposure (Nau 1987).

As a class, penicillin antibiotics are widely used in pregnant women. Based on available data, penicillin antibiotics are generally considered compatible for use during pregnancy (Ailes 2016; Bookstaver 2015; Crider 2009; Damkier 2019; Lamont 2014; Muanda 2017a; Muanda 2017b).

Monitoring Parameters

CBC with differential, kidney and liver function tests; observe for changes in bowel frequency. Monitor for hypersensitivity (including anaphylaxis).

Mechanism of Action

Inhibits bacterial cell wall synthesis by binding to one or more of the penicillin-binding proteins (PBPs) which in turn inhibit the final transpeptidation step of peptidoglycan synthesis in bacterial cell walls, thus inhibiting cell wall biosynthesis. Bacteria eventually lyse due to ongoing activity of cell wall autolytic enzymes (autolysins and murein hydrolases) while cell wall assembly is arrested.

Pharmacokinetics (Adult Data Unless Noted)

Absorption: Oral: ~50%; reduced by food

Distribution: Widely to most body fluids and bone; penetration into cells, into eye, and across normal meninges is poor; inflammation increases amount that crosses blood-brain barrier

Protein binding: ~94% (primarily albumin)

Metabolism: Hepatic to active and inactive metabolites

Half-life elimination: 0.5 to 1.5 hours; prolonged with renal impairment and in neonates

Time to peak, serum: Oral: ~1 hour

Excretion: Urine and feces

Brand Names: International
International Brand Names by Country
For country code abbreviations (show table)

  • (AE) United Arab Emirates: Monoclox | Orbenin;
  • (BD) Bangladesh: A-Clox | Adclox | Aldaclox | Ambeeclox | Aristoclox | Bactaclox | Betaclox | Biclox | Bitacep | Bpclox | Clobex | Cloxa | Cloxapen | Cloxi-Z | Cloxicap | Cloxiject | Cloxil | Cloxilin | Cloxima | Cloxin | Cloxisyrup | Cloxpen | Eclox | Ficlox | G-cloxacillin | Hi-Clox | Jp clox | Loxacin | Lysiclox | Miclocin | Navaclox | Neuclox | Omniclox | Penclox | Reclox | Remaclox | Simpiclox | Sinaclox | T-Clox | Tyclox | Ultraclox | Xeclox;
  • (BE) Belgium: Orbenin | Penstaphon;
  • (BF) Burkina Faso: Cloxacilline;
  • (BG) Bulgaria: Cloxacillin;
  • (BR) Brazil: Bactopen;
  • (CH) Switzerland: Orbenin;
  • (CI) Côte d'Ivoire: Caxol;
  • (CL) Chile: Cloxacilina;
  • (CN) China: Ao ge lin | Cloxacillin | Gao fen | Kai li | Kang ni li xing | Li da xin | Nuo kai | Pu kang bei | Rui pu lin | Tang nuo | Ya jun lin | Zhan ning;
  • (CO) Colombia: Prostafilina a;
  • (EE) Estonia: Orbenil;
  • (ES) Spain: Anaclosil | Cloxacilina Ips | Cloxacilina normon | Orbenin;
  • (ET) Ethiopia: Clox | Cloxacillin;
  • (FI) Finland: Cloxacillin navamedic | Cloxacillin vital pharma nordic | Ekvacillin | Staflocil;
  • (FR) France: Cloxacillin sandoz | Cloxacilline arrow | Cloxacilline biogaran | Cloxacilline eg | Cloxacilline mylan | Cloxacilline panpharma | Cloxacilline stragen | Cloxacilline zentiva | Cloxypen | Orbenine | Staphybiotic;
  • (GB) United Kingdom: Cloxacillin | Cloxacillin cox | Orbenin;
  • (GR) Greece: Anaclosil | Cloxacillin/Remedica | Orbenin | Staphyclox;
  • (HK) Hong Kong: Apo-cloxi | Cloxa | Cloxacap | Cloxacillin | Cloxacin | Lidoxin | Monoclox | Orbenin | Syncillin;
  • (HR) Croatia: Orbenin;
  • (ID) Indonesia: Ikaclox | Meixam | Orbenin;
  • (IE) Ireland: Orbenin;
  • (IL) Israel: Loxavit | Orbenil;
  • (IN) India: Bioclox | Clin | Clopen | Cloxacillin | Cloxin | Klox | Nexiclox ds | Staphnil;
  • (JO) Jordan: Monoclox | Prostaphlin A;
  • (JP) Japan: Methocillin s | Orbenin;
  • (KE) Kenya: Cloxacillin | Cloxispa | Dawaclox | Kloxy | Mediclox | Nelox;
  • (KR) Korea, Republic of: Orbrex;
  • (KW) Kuwait: Monoclox | Orbenin;
  • (LB) Lebanon: Cloxacil | Cloxacillin | Cloxacilline | Cloxacilline arrow | Orbenin | Prostaphlin A;
  • (LT) Lithuania: Cloxacillin | Syntarpen;
  • (LU) Luxembourg: Orbenin;
  • (LV) Latvia: Cloxacillin;
  • (MY) Malaysia: Axocillin | Cloxa | Cloxabiotic | Cloxacap | Cloxacilla | Cloxacillin | Cloxacillin Pharmaniaga | Cloxcin | Cloxicap | Cloxil | Cloxillin | Dyna Cloxacillin | Isoxacillin | Loxamycin | Monoclox;
  • (NG) Nigeria: Cloxacillin;
  • (NL) Netherlands: Cloxacilline gf | Orbenin;
  • (NO) Norway: Cloxacillin | Cloxacillin navamedic | Cloxacillin navamedic nordic | Cloxacillin stragen | Cloxacillin villerton | Ekvacillin;
  • (OM) Oman: Cloxadar;
  • (PE) Peru: Cloxacilina | Prostafilina a;
  • (PH) Philippines: Avastoph | Axillin | Boie cloxacillin | Caxin | Ciclox | Cillox | Clocsamed | Clofinil | Clonacil | Clopen | Clovex | Clox | Cloxacillin | Cloxacillin Diamond | Cloxacillin Interpharm | Cloxacillin Sydenham | Cloxacin | Cloxakid | Cloxal | Cloxalin | Cloxceena | Cloxid | Cloxigen | Cloxil | Cloxin | Cloxipen | Corstaph | Cyclox | Diacil | Diaclox | Dialox | Eloxil | Encloxil | Eraclox | Farmclox | Flactamacin | Kloxitas | Lewinex | Medaclox | Mediclox | Medix | Myreclox | Nacloxin | Nalixol | Nocloxol | Orbenin | Oxaclen | Oxeed | Pannox | Patriflex | Pharex cloxacillin | Prostaphlin A | RiteMED Cloxacillin | Secloxin | Solaze | Sydenclox | Vamcloxil | Vivarin | Zeflodan;
  • (PK) Pakistan: Auropen | Boschoclox | Cloxcin | Loxacin | Novoclox | Orbenin | Tabroclox;
  • (PL) Poland: Syntarpen;
  • (QA) Qatar: Klox | Monoclox;
  • (SA) Saudi Arabia: Monoclox | Orbenin;
  • (SE) Sweden: Cloxacillin navamedic | Cloxacillin stragen | Cloxacillin vital pharma nordic | Ekvacillin;
  • (SG) Singapore: Apo-cloxi | Axocillin | Cloxacap | Cloxacillin | Cloxacillin stragen | Cloxcin | Cloxillin | Lidoxin | Monoclox | Orbenin | Procap-C;
  • (SI) Slovenia: Anaclosil | Cloxacilina normon | Cloxacillin stragen | Orbenin;
  • (SL) Sierra Leone: Cloxacillin;
  • (TH) Thailand: Axocillin | C Cloxa | Cloxa | Cloxa m h | Cloxa T M N | Cloxacan | Cloxacap | Cloxacel | Cloxacillin | Cloxalin | Cloxam | Cloxamed | Cloxan | Cloxanbin | Cloxano | Cloxapan | Cloxasian | Cloxasin | Cloxasol | Cloxatin | Cloxcillin | Cloxcin | Cloxgen | Cloxil | Cloxin | Cloxino | Cloxlin | Cloxolen | Cloxomed | Cloxpac | Cloxstar | Coclox | Corbin | Greater-gloxa | K-cil | Kressxalin | Lidoxin | Lincox | Loxzalin | Medcloxa | Meiclox | Monoclox | Orbenin | Panoxilin | Pharclox | Pinclox | S Cloxin | Serviclox | Sinocloxin | Socloxin | Specclox | Staphoclox | Syntoclox | Theraclox | Ticlox | Vaclox | Vicloxa | Xalin;
  • (TW) Taiwan: Cloxacillin | Orbenin | Prostaphlin A;
  • (UG) Uganda: Agoclox | Alclox | Bruclox | Cloxacillin | Cloxaren | Cloxcin | Cloxin | Cloxispa | Dawaclox | Kamcloxa | Kloxy | Uclox;
  • (VE) Venezuela, Bolivarian Republic of: Orbenin;
  • (ZA) South Africa: Cloxacillin fresenius | Cloxin | Orbenin | Rolab-cloxacillin;
  • (ZM) Zambia: Alclox | Cloxacillin | Cloxafil | Cloxasafe | Cloxil | Cloxin | Cloxispa | Klox | Symaclox;
  • (ZW) Zimbabwe: Cloxacillin | Iclox
  1. Ailes EC, Gilboa SM, Gill SK, et al. Association between antibiotic use among pregnant women with urinary tract infections in the first trimester and birth defects, National Birth Defects Prevention Study 1997 to 2011. Birth Defects Res A Clin Mol Teratol. 2016;106(11):940-949. doi:10.1002/bdra.23570 [PubMed 27891788]
  2. Apo-Cloxi (cloxacillin) [product monograph]. Toronto, Ontario, Canada: Apotex Inc; July 2020.
  3. Apo-Cloxi (cloxacillin) [product monograph]. Weston, Ontario, Canada: Apotex Inc; November 2000.
  4. Bai AD, Showler A, Burry L, et al. Comparative effectiveness of cefazolin versus cloxacillin as definitive antibiotic therapy for MSSA bacteraemia: results from a large multicentre cohort study. J Antimicrob Chemother. 2015;70(5):1539-1546. doi:10.1093/jac/dku560 [PubMed 25614044]
  5. Bookstaver PB, Bland CM, Griffin B, Stover KR, Eiland LS, McLaughlin M. A review of antibiotic use in pregnancy. Pharmacotherapy. 2015;35(11):1052-1062. doi:10.1002/phar.1649 [PubMed 26598097]
  6. Burdet C, Loubet P, Le Moing V, et al; CloCeBa study group. Efficacy of cloxacillin versus cefazolin for methicillin-susceptible Staphylococcus aureus bacteraemia (CloCeBa): study protocol for a randomised, controlled, non-inferiority trial. BMJ Open. 2018;8(8):e023151. doi:10.1136/bmjopen-2018-023151 [PubMed 30173161]
  7. Chauhan S, Jain S, Varma S, Chauhan SS. Tropical pyomyositis (myositis tropicans): current perspective. Postgrad Med J. 2004;80(943):267-270. doi:10.1136/pgmj.2003.009274 [PubMed 15138315]
  8. Choon SE, Der YS, Lai NLJ, Yu SEE, Yap XL, Nalini NM. Clinical characteristics, culprit drugs and outcome of patients with acute generalised exanthematous pustulosis seen in hospital Sultanah Aminah, Johor Bahru. Med J Malaysia. 2018;73(4):220-225. [PubMed 30121684]
  9. Chou AC, Mahadev A. The use of C-reactive protein as a guide for transitioning to oral antibiotics in pediatric osteoarticular infections. J Pediatr Orthop. 2016;36(2):173-177. doi:10.1097/BPO.0000000000000427 [PubMed 25929777]
  10. Cloxacillin injection [product monograph]. Oakville, Ontario, Canada: SteriMax Inc; February 2019.
  11. Crider KS, Cleves MA, Reefhuis J, Berry RJ, Hobbs CA, Hu DJ. Antibacterial medication use during pregnancy and risk of birth defects: National Birth Defects Prevention Study. Arch Pediatr Adolesc Med. 2009;163(11):978-985. doi:10.1001/archpediatrics.2009.188 [PubMed 19884587]
  12. Crochette R, Ravaiau C, Perez L, Coindre JP, Piccoli GB, Blanchi S. Incidence and risk factors for acute kidney injury during the treatment of methicillin-sensitive Staphylococcus aureus infections with cloxacillin based antibiotic regimens: a French retrospective study. J Clin Med. 2021;10(12):2603. doi:10.3390/jcm10122603 [PubMed 34204743]
  13. Damkier P, Brønniche LMS, Korch-Frandsen JFB, Broe A. In utero exposure to antibiotics and risk of congenital malformations: a population-based study. Am J Obstet Gynecol. 2019;221(6):648.e1-648.e15. doi:10.1016/j.ajog.2019.06.050 [PubMed 31260651]
  14. Delgado V, Ajmone Marsan N, de Waha S, et al. 2023 ESC Guidelines for the management of endocarditis. Eur Heart J. 2023;44(39):3948-4042. doi:10.1093/eurheartj/ehad193 [PubMed 37622656]
  15. El Nekidy W, Dziamarski N, Soong D, Donaldson C, Ibrahim M, Kadri A. Cloxacillin-induced seizure in a hemodialysis patient. Hemodial Int. 2015;19(4):E33-E36. doi:10.1111/hdi.12262 [PubMed 25582344]
  16. Enat R, Pollack S, Ben-Arieh Y, et al, “Cholestatic Jaundice Caused by Cloxacillin: Macrophage Inhibition Factor Test in Preventing Rechallenge With Hepatotoxic Drugs,” Br Med J, 1980, 280(6219):982-83. [PubMed 7417768]
  17. Euba G, Murillo O, Fernández-Sabé N, et al. Long-term follow-up trial of oral rifampin-cotrimoxazole combination versus intravenous cloxacillin in treatment of chronic staphylococcal osteomyelitis. Antimicrob Agents Chemother. 2009;53(6):2672-2676. doi:10.1128/AAC.01504-08 [PubMed 19307354]
  18. Expert opinion. Senior Renal Editorial Team: Bruce Mueller, PharmD, FCCP, FASN, FNKF; Jason A. Roberts, PhD, BPharm (Hons), B App Sc, FSHP, FISAC; Michael Heung, MD, MS.
  19. Faragalla K, Lau H, Wang HL, Liu J. Cloxacillin-induced acute vanishing bile duct syndrome: a case study and literature review. Br J Clin Pharmacol. 2022;88(10):4633-4638. doi:10.1111/bcp.15445 [PubMed 35730139]
  20. García-Porrúa C, González-Gay MA, López-Lázaro L. Drug associated cutaneous vasculitis in adults in northwestern Spain. J Rheumatol. 1999;26(9):1942-1944. [PubMed 10493674]
  21. Goland S, Malnick SD, Gratz R, Feldberg E, Geltner D, Sthoeger ZM. Severe cholestatic hepatitis following cloxacillin treatment. Postgrad Med J. 1998;74(867):59-60. doi:10.1136/pgmj.74.867.59 [PubMed 9538497]
  22. Grimm PC, Ogborn MR, Larson AJ, Crocker JF. Interstitial nephritis induced by cloxacillin. Nephron. 1989;51(2):285-286. doi:10.1159/000185306 [PubMed 2915772]
  23. Habib G, Lancellotti P, Antunes MJ, et al; ESC Scientific Document Group. 2015 ESC guidelines for the management of infective endocarditis: the task force for the management of infective endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J. 2015;36(44):3075-3128. doi:10.1093/eurheartj/ehv319 [PubMed 26320109]
  24. Ito S, Blajchman A, Stephenson M, Eliopoulos C, Koren G. Prospective follow-up of adverse reactions in breast-fed infants exposed to maternal medication. Am J Obstet Gynecol. 1993;168(5):1393-1399. doi:10.1016/s0002-9378(11)90771-6 [PubMed 8498418]
  25. Jadavji T, Law B, Lebel MH, Kennedy WA, Gold R, Wang EE. A practical guide for the diagnosis and treatment of pediatric pneumonia. CMAJ. 1997;156(5):S703-S711. [PubMed 9068582]
  26. JAMP Cloxacillin (cloxacillin) [product monograph]. Boucherville, Quebec, Canada: JAMP Pharma Corporation; January 2021.
  27. Jayaweera JAAS, Abeydeera WPH, Ranasinghe GR. Intravenously administered cloxacillin-induced neutropenia with eosinophilia in a patient with infective endocarditis: a case report. J Med Case Rep. 2018;12(1):384. doi:10.1186/s13256-018-1933-3 [PubMed 30593283]
  28. Lamont HF, Blogg HJ, Lamont RF. Safety of antimicrobial treatment during pregnancy: a current review of resistance, immunomodulation and teratogenicity. Expert Opin Drug Saf. 2014;13(12):1569-1581. doi:10.1517/14740338.2014.939580 [PubMed 25189188]
  29. Lavergne A, Vigneau C, Polard E, et al. Acute kidney injury during treatment with high-dose cloxacillin: a report of 23 cases and literature review. Int J Antimicrob Agents. 2018;52(3):344-349. doi:10.1016/j.ijantimicag.2018.04.007 [PubMed 29665445]
  30. Legg A, Meagher N, Johnson SA, et al. Correction to: risk factors for nephrotoxicity in methicillin-resistant Staphylococcus aureus bacteraemia: a post hoc analysis of the CAMERA2 trial. Clin Drug Investig. Published online November 19, 2022. doi:10.1007/s40261-022-01224-9 [PubMed 36401785]
  31. Le Saux N. Diagnosis and management of acute osteoarticular infections in children. Paediatr Child Health. 2018;23(5):336-343. doi:10.1093/pch/pxy049 [PubMed 30653632]
  32. Macheda G, El Helali N, Péan de Ponfilly G, et al. Impact of therapeutic drug monitoring of antibiotics in the management of infective endocarditis. Eur J Clin Microbiol Infect Dis. 2022;41(9):1183-1190. doi:10.1007/s10096-022-04475-8 [PubMed 35984543]
  33. Mani SSR, Iyyadurai R. Cloxacillin induced agranulocytosis: a rare adverse event of a commonly used antibiotic. Int J Immunopathol Pharmacol. 2017;30(3):297-301. doi:10.1177/0394632017724320 [PubMed 28786715]
  34. Mathur S, Jackson C, Urus H, et al. A comparison of five paediatric dosing guidelines for antibiotics. Bull World Health Organ. 2020;98(6):406-412F. doi:10.2471/BLT.19.234310 [PubMed 32514214]
  35. Matsuda S. Transfer of antibiotics into maternal milk. Biol Res Pregnancy Perinatol. 1984;5(2):57-60. [PubMed 6743732]
  36. Mermel LA, Allon M, Bouza E, et al. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis. 2009;49(1):1-45. doi:10.1086/599376 [PubMed 19489710]
  37. Monoclox (cloxacillin) [summary of product characteristics]. Limassol, Cyprus: Medochemie Ltd; August 2020.
  38. Moreno-Ancillo A, Domínguez-Noche C, Gil-Adrados AC, Cosmes PM. Near-fatal delayed hypersensitivity reaction to cloxacillin. Contact Dermatitis. 2003;49(1):44-45. doi:10.1111/j.0105-1873.2003.0120d.x [PubMed 14641124]
  39. Muanda FT, Sheehy O, Bérard A. Use of antibiotics during pregnancy and risk of spontaneous abortion. CMAJ. 2017b;189(17):E625-E633. doi:10.1503/cmaj.161020 [PubMed 28461374]
  40. Muanda FT, Sheehy O, Bérard A. Use of antibiotics during pregnancy and the risk of major congenital malformations: a population based cohort study. Br J Clin Pharmacol. 2017a;83(11):2557-2571. doi:10.1111/bcp.13364 [PubMed 28722171]
  41. Nagasayi S, Yan SH, Chiong C. Refractory hypokalaemia in an elderly patient. BMJ. 2017;357:j1575. doi:10.1136/bmj.j1575 [PubMed 28404586]
  42. Nau H. Clinical pharmacokinetics in pregnancy and perinatology. II. Penicillins. Dev Pharmacol Ther. 1987;10(3):174-198. doi:10.1159/000457744 [PubMed 3301235]
  43. Nauta EH, Mattie H, Goslings WR. Pharmacokinetics of cloxacillin in patients on chronic intermittent haemodialysis and in healthy subjects. Chemotherapy. 1973;19(5):261-271. doi:10.1159/000221464 [PubMed 4595633]
  44. Nelson JD, Howard JB, and Shelton S, “Oral Antibiotic Therapy for Skeletal Infections of Children. I. Antibiotic Concentrations in Suppurative Synovial Fluid,” J Pediatr, 1978, 92(1):131-4. [PubMed 619055]
  45. Neuville M, El-Helali N, Magalhaes E, et al. Systematic overdosing of oxa- and cloxacillin in severe infections treated in ICU: risk factors and side effects. Ann Intensive Care. 2017;7(1):34. doi:10.1186/s13613-017-0255-8 [PubMed 28332157]
  46. Pichichero ME, “Group A Beta-Hemolytic Streptococcal Infections,” Pediatr Review, 1998, 19(9):291-302. [PubMed 9745311]
  47. Refer to manufacturer's labeling.
  48. Rodríguez-Jiménez B, Domínguez-Ortega J, Santos-Magadán S, González-García JM, Kindelan-Recarte C. Cloxacillin-induced skin eruption. Clin Exp Dermatol. 2009;34(7):e330-e331. doi:10.1111/j.1365-2230.2009.03281.x [PubMed 19456773]
  49. Ruch Y, Ursenbach A, Danion F, et al. High incidence of acute kidney injury in patients treated with high-dose amoxicillin and cloxacillin combination therapy. Antibiotics (Basel). 2022;11(6):770. doi:10.3390/antibiotics11060770 [PubMed 35740176]
  50. Saavedra-Lozano J, Falup-Pecurariu O, Faust SN, et al. Bone and joint infections. Pediatr Infect Dis J. 2017;36(8):788-799. doi:10.1097/INF.0000000000001635 [PubMed 28708801]
  51. St. John MA, Prober CG. Side effects of cloxacillin in infants and children. Can Med Assoc J. 1981;125(5):458-460. [PubMed 7284928]
  52. Teva-Cloxacillin (cloxacillin) [product monograph]. Toronto, Canada: Teva Canada Limited; March 2020.
  53. Teva-Cloxacillin (cloxacillin) [product monograph]. Toronto, Canada: Teva Canada Limited; September 2016.
  54. Verdier MC, Tribut O, Tattevin P, Michelet C, Bentué-Ferrer D. Assessment of interindividual variability of plasma concentrations after administrazion of high doses of intravenous amoxicillin or cloxacillin in critically ill patients. J Chemother. 2011;23(5):277-281. doi:10.1179/joc.2011.23.5.277 [PubMed 22005059]
  55. Westerman EL, Bradshaw MW, and Williams TW, “Agranulocytosis During Therapy With Orally Administered Cloxacillin,” Am J Clin Pathol, 1978, 69(5):559-60. [PubMed 655134]
  56. Woods CR, Bradley JS, Chatterjee A, et al. Clinical practice guideline by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America (PIDS/IDSA): 2021 guideline on diagnosis and management of acute hematogenous osteomyelitis in pediatrics. J Pediatric Infect Dis Soc. 2021;10(8):801-844. doi:10.1093/jpids/piab027 [PubMed 34350458]
  57. Woods CR, Bradley JS, Chatterjee A, et al. Clinical practice guideline by the Pediatric Infectious Diseases Society (PIDS) and the Infectious Diseases Society of America (IDSA): 2023 guideline on diagnosis and management of acute bacterial arthritis in pediatrics. J Pediatric Infect Dis Soc. Published online November 6, 2023. doi:10.1093/jpids/piad089 [PubMed 37941444]
  58. World Health Organization (WHO). Breastfeeding and maternal medication, recommendations for drugs in the eleventh WHO model list of essential drugs. 2002. Available at http://www.who.int/maternal_child_adolescent/documents/55732/en/. Accessed May 27, 2020.
  59. World Health Organization (WHO). Pocket Book of Hospital Care for Children: Guidelines for the Management of Common Childhood Illnesses. 2nd ed. Geneva: World Health Organization; 2013. [PubMed 24006557]
  60. World Health Organization (WHO). WHO model prescribing information: drugs used in bacterial infections. https://apps.who.int/iris/handle/10665/42372. Published 2001. Accessed June 9, 2021.
  61. Wright AJ, “The Penicillins,” Mayo Clin Proc, 1999, 74(3):290-307. [PubMed 10090000]
  62. Zezos P, Harel Z, Saibil F. Cloxacillin: a new cause of pill-induced esophagitis. Can J Gastroenterol Hepatol. 2016;2016:2904256. doi:10.1155/2016/2904256 [PubMed 27446834]
Topic 147259 Version 4.0