DailyMed Label: Oxacillin

DailyMed Label: Oxacillin

2023

DailyMed Prescription

Oxacillin

Oxacillin

Wockhardt USA LLC.

NDC: 64679-698

NDC: 64679-699

NDC: 64679-698

NDC: 64679-699

NDC: 64679-698

NDC: 64679-699

NDC: 64679-698

NDC: 64679-699

NDC: 64679-698

NDC: 64679-698

NDC: 64679-699

NDC: 64679-699

Oxacillin for injection, USP is a sterile product for intramuscular or intravenous administration. Oxacillin for injection, USP contains oxacillin sodium, a semisynthetic penicillin derived from the penicillin nucleus, 6-aminopenicillanic acid. It is resistant to inactivation by the enzyme penicillinase (beta-lactamase). Each vial contains oxacillin sodium monohydrate equivalent to 1 gram or 2 grams of oxacillin. The sodium content is 64 mg (2.8 mEq) per gram of oxacillin. The product is buffered with 21 mg dibasic sodium phosphate per gram of oxacillin. Oxacillin for injection, USP is white to off white powder and gives a clear solution upon reconstitution. OXACILLIN SODIUM The chemical name of oxacillin sodium is 4-Thia-1-azabicyclo [3.2.0]heptane-2-carboxylic acid, 3,3-dimethyl-6-[[(5-methyl-3-phenyl-4-isoxazolyl) carbonyl] amino]-7-oxo-, monosodium salt, monohydrate, [2S(2α,5α,6β)]. It is resistant to inactivation by the enzyme penicillinase (beta-lactamase). The molecular formula of oxacillin sodium is C 19 H 18 N 3 NaO 5 S•H 2 O. The molecular weight is 441.43. Structure

Oxacillin is indicated in the treatment of infections caused by penicillinase producing staphylococci which have demonstrated susceptibility to the drug. Cultures and susceptibility tests should be performed initially to determine the causative organism and its susceptibility to the drug. (See CLINICAL PHARMACOLOGY: Susceptibility Test Methods ). Oxacillin may be used to initiate therapy in suspected cases of resistant staphylococcal infections prior to the availability of susceptibility test results. Oxacillin should not be used in infections caused by organisms susceptible to penicillin G. If the susceptibility tests indicate that the infection is due to an organism other than a resistant Staphylococcus , therapy should not be continued with oxacillin. To reduce the development of drug-resistant bacteria and maintain the effectiveness of Oxacillin for Injection, USP and other antibacterial drugs, Oxacillin for Injection, USP should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria. When culture and susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy. In the absence of such data, local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy.

Bacteriologic studies to determine the causative organisms and their susceptibility to oxacillin should always be performed. Duration of therapy varies with the type of severity of infection as well as the overall condition of the patient, therefore it should be determined by the clinical and bacteriological response of the patient. In severe staphylococcal infections, therapy with oxacillin should be continued for at least 14 days. Therapy should be continued for at least 48 hours after the patient has become afebrile, asymptomatic, and cultures are negative. Treatment of endocarditis and osteomyelitis may require a longer duration of therapy. With intravenous administration, particularly in elderly patients, care should be taken because of the possibility of thrombophlebitis. RECOMMENDED DOSAGES FOR OXACILLIN FOR INJECTION, USP Drug Adults Infants  and  Children < 40  kg  ( 88  lbs ) Other Recommendations Oxacillin 250 to 500 mg  IM or IV every  4 to 6 hours  (mild to moderate infections) 50 mg/kg/day  IM or IV in equally  divided doses every  6 hours (mild to  moderate infections) 1 gram IM or IV  every 4 to 6 hours  (severe infections) 100 mg/kg/day  IM or IV in equally divided doses every  4 to 6 hours  (severe infections) Premature and Neonates  25 mg/kg/day  IM or IV For Intramuscular Use: Use Sterile Water for Injection, USP. Add 5.4 mL to the 1 gram vial and 10.6 mL to the 2 gram vial. Shake well until a clear solution is obtained. After reconstitution, vials will contain 250 mg of active drug per 1.5 mL of solution. The reconstituted solution is stable for 3 days at 70° F or for one week under refrigeration (40° F). For Direct Intravenous Use: Use Sterile Water for Injection, USP or Sodium Chloride Injection, USP. Add 10 mL to the 1 gram vial and 20 mL to the 2 gram vial. Withdraw the entire contents and administer slowly over a period of approximately 10 minutes. For Administration by Intravenous Drip: Reconstitute as directed above ( For Direct Intravenous Use ) prior to diluting with Intravenous Solution. STABILITY PERIODS FOR OXACILLIN FOR INJECTION, USP Concentration mg / mL Sterile Water  for Injection , USP 0 . 9 % Sodium Chloride Injection , USP M / 6  Molar  Sodium Lactate Solution 5 % Dextrose in  water 5 % Dextrose in  0 . 45 % Sodium Chloride 10 % Invert Sugar Injection , USP Lactated Ringers Solution ROOM  TEMPERATURE  ( 25 ° C ) 10 to 100 4 Days 4 Days 10 to 30 24 Hrs 24 Hrs 0.5 to 2 6 Hrs 6 Hrs 6 Hrs REFRIGERATION  ( 4 ° C ) 10 to 100 7 Days 7 Days 10 to 30 4 Days 4 Days 4 Days 4 Days 4 Days FROZEN  (- 15 ° C ) 50 to 100 30 Days 250/1.5 mL 30 Days 100 30 Days 10 to 100 30 Days 30 Days 30 Days 30 Days 30 Days Stability studies on Oxacillin Sodium at concentrations of 0.5 mg/mL and 2 mg/mL in various intravenous solutions listed below indicate the drug will lose less than 10% activity at room temperature (70°F) during a 6-hour period. IV Solution 5% Dextrose in Normal Saline Only those solutions listed above should be used for the intravenous infusion of oxacillin sodium. The concentration of the antibiotic should fall within the range specified. The drug concentration and the rate and volume of the infusion should be adjusted so that the total dose of oxacillin is administered before the drug loses its stability in the solution in use. If another agent is used in conjunction with oxacillin therapy, it should not be physically mixed with oxacillin but should be administered separately. Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration whenever solution and container permit. Do not add supplementary medication to oxacillin for injection, USP.

A history of a hypersensitivity (anaphylactic) reaction to any penicillin is a contraindication.

Oxacillin 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 for 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. Periodic assessment of organ system function including renal, hepatic, and hematopoietic should be made during prolonged therapy with oxacillin. 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. 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. Tetracycline, a bacteriostatic antibiotic, may antagonize the bactericidal effect of penicillin and concurrent use of these drugs should be avoided. Oxacillin blood levels may be increased and prolonged by concurrent administration of probenecid which blocks the renal tubular secretion of penicillins. Probenecid decreases the apparent volume of distribution and slows the rate of excretion by competitively inhibiting renal tubular secretion of penicillins. Oxacillin-probenecid therapy should be limited to those infections where very high serum levels of oxacillin are necessary. 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). Teratogenic Effects 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 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. Clinical studies of oxacillin for 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 for Injection contains 64 mg (2.8 mEq) of sodium per gram of oxacillin. At the usual recommended doses, patients would receive between 64 and 384 mg/day (2.8 and 16.7 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. Patients should be counseled that antibacterial drugs including Oxacillin for Injection, USP should only be used to treat bacterial infections. They do not treat viral infections (e.g., the common cold). When Oxacillin for Injection, USP is prescribed to treat a bacterial infection, patients should be told that although it is common to feel better early in the course of therapy, the medication should be taken exactly as directed. Skipping doses or not completing the full course of therapy may: (1) decrease the effectiveness of the immediate treatment, and (2) increase the likelihood that bacteria will develop resistance and will not be treatable by Oxacillin for Injection, USP or other antibacterial drugs in the future. Diarrhea is a common problem caused by antibiotics which usually ends when the antibiotic is discontinued. Sometimes after starting treatment with antibiotics, patients can develop watery and bloody stools (with or without stomach cramps and fever) even as late as two or more months after having taken the last dose of the antibiotic. If this occurs, patients should contact their physician as soon as possible.

The reported incidence of allergic reactions to penicillin ranges from 0.7 to 10 percent (see

Tetracycline, a bacteriostatic antibiotic, may antagonize the bactericidal effect of penicillin and concurrent use of these drugs should be avoided. Oxacillin blood levels may be increased and prolonged by concurrent administration of probenecid which blocks the renal tubular secretion of penicillins. Probenecid decreases the apparent volume of distribution and slows the rate of excretion by competitively inhibiting renal tubular secretion of penicillins. Oxacillin-probenecid therapy should be limited to those infections where very high serum levels of oxacillin are necessary.

Oxacillin for injection, USP contains oxacillin sodium equivalent to 1 or 2 grams oxacillin per vial. NDC 64679-698-01    1 gram vial, packaged in carton of ten vials NDC 64679-698-03    1 gram vial, packaged in carton of one vial NDC 64679-699-01    2 grams vial, packaged in carton of ten vials NDC 64679-699-03    2 grams vial, packaged in carton of one vial Store dry powder at 20°-25°C (68°-77°F) [See USP Controlled Room Temperature]. Manufactured by: Mitim S.r.l. Via Cacciamali n°34-36-38 25125 Brescia (BS), Italy Distributed by: Wockhardt USA LLC. 20 Waterview Blvd. Parsippany, NJ 07054 USA Rev.121118

Intravenous administration provides peak serum levels approximately 5 minutes after the injection is completed. Slow I.V. administration of 500 mg gives a peak serum level of 43 mcg/mL after 5 minutes with a half-life of 20 to 30 minutes. Oxacillin sodium, with normal doses, has insignificant concentrations in the cerebrospinal and ascitic fluids. It is found in therapeutic concentrations in the pleural, bile, and amniotic fluids. Oxacillin sodium is rapidly excreted as unchanged drug in the urine by glomerular filtration and active tubular secretion. The elimination half-life for oxacillin is about 0.5 hours. Nonrenal elimination includes hepatic inactivation and excretion in bile. Oxacillin sodium binds to serum protein, mainly albumin. The degree of protein binding reported varies with the method of study and the investigator, but generally has been found to be 94.2 ± 2.1%. Probenecid blocks the renal tubular secretion of penicillins. Therefore, the concurrent administration of probenecid prolongs the elimination of oxacillin and, consequently, increases the serum concentration. Intramuscular injections give peak serum levels 30 minutes after injection. A 250 mg dose gives a level of 5.3 mcg/mL while a 500 mg dose peaks at 10.9 mcg/mL. Intravenous injection gives a peak about 5 minutes after the injection is completed. Slow IV dosing with 500 mg gives a 5 minute peak of 43 mcg/mL with a half-life of 20 to 30 minutes. Mode of Action Penicillinase-resistant penicillins exert a bactericidal action against penicillin susceptible microorganisms during the state of active multiplication. All penicillins inhibit the biosynthesis of the bacterial cell wall. Resistance to penicillins may be mediated by destruction of the beta-lactam ring by a beta-lactamase, altered affinity of penicillin for target, or decreased penetration of the antibiotic to reach the target site. Resistance to oxacillin (or cefoxitin) implies resistance to all other beta-lactam agents, except newer agents with activity against methicillin-resistant Staphylococcus aureus. For specific information regarding susceptibility test interpretive criteria and associated test methods and quality control standards recognized by FDA for this drug, please see: https://www.fda.gov/STIC.

DRUG: Oxacillin Sodium GENERIC: Oxacillin Sodium DOSAGE: Injection ADMINSTRATION: Intramuscular, Intravenous NDC: 64679-698-02 STRENGTH: 1 gram/vial QTY: 1 gram vial label DRUG: Oxacillin Sodium GENERIC: Oxacillin Sodium DOSAGE: Injection ADMINSTRATION: Intramuscular, Intravenous NDC: 64679-699-02 STRENGTH: 2 grams/vial QTY: 2 grams vial label 1 gram label 1 gram label 2 grams label 2 grams label