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INTRODUCTION

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cloxacillin (klox-a-sill-in)

Apo-Cloxi, Cloxapen, Novo-Cloxin, Nu-Cloxi, Orbenin

Classification

Therapeutic: anti-infectives

Pharmacologic: penicillinase-resistant penicillins

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Indications
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Treatment of the following infections due to penicillinase-producing staphylococci: Respiratory tract infections, Sinusitis, Skin and skin structure infections.

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Action
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Bind to bacterial cell wall, leading to cell death. Not inactivated by penicillinase enzymes. Therapeutic Effects: Bactericidal action. Spectrum: Active against most gram-positive aerobic cocci. Spectrum is notable for activity against Penicillinase-producing strains of Staphylococcus aureus, S. epidermidis. Not active against methicillin-resistant bacteria.

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Adverse Reactions/Side Effects
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CNS: SEIZURES. GI: diarrhea, epigastric distress, nausea, vomiting, pseudomembranous colitis. GU: interstitial nephritis. Derm: rash, urticaria. Hemat: eosinophilia, leukopenia. Misc: ALLERGIC REACTIONS, INCLUDING ANAPHYLAXIS AND SERUM SICKNESS, superinfection.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Watch for seizures; notify physician immediately if patient develops or increases seizure activity.

  • Monitor signs of allergic reactions and anaphylaxis, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough dyspnea) or skin reactions (rash, pruritus, urticaria). Notify physician or nursing staff immediately if these reactions occur.

  • Assess muscle aches and joint pain (arthralgia) that may be caused by serum sickness. Notify physician if these symptoms seem to be drug related rather than caused by musculoskeletal injury, or if muscle and joint pain are accompanied by allergy-like reactions (fever, rashes, etc.)

  • Monitor signs of eosinophilia (fatigue, weakness, myalgia) or leukopenia (fever, sore throat, signs of infection); report these signs to the physician.

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Interventions
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  • Always wash hands thoroughly and disinfect equipment (whirlpools, electrotherapeutic devices, treatment tables, and so forth) to help prevent the spread of infection. Employ universal precautions or isolation procedures as indicated for specific patients.

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Patient/Client-Related Instruction
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  • Instruct patient to notify physician immediately if signs of the following occur:

    • Pseudomembranous colitis (diarrhea, abdominal pain, fever, pus or mucus in stools) or other severe or prolonged GI problems (nausea, vomiting, heartburn).

    • Superinfection (black, furry overgrowth on tongue; vaginal itching or discharge; loose or foul-smelling stools).

    • Interstitial nephritis (blood in urine, decreased urine output, weight gain from fluid retention).

  • Instruct patient and family/caregivers to report other troublesome side effects such as severe or prolonged skin problems (rash, itching) or GI problems (nausea, vomiting, diarrhea, heartburn).

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Pharmacokinetics
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Absorption: Moderately absorbed (50%) following oral administration.

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Distribution: Widely distributed; penetration into CSF is minimal but sufficient in the presence of inflamed meninges; crosses the placenta and enters breast milk.

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Metabolism and Excretion: Some metabolism by the liver (9–22%) and some renal excretion of unchanged drug (30–45%).

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Half-life: 0.5–1.1 hr (increased in severe hepatic, in renal dysfunction, and in neonates).

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