Cloxacillin instead of dicloxacillin

Question

I have a patient who has chronic severe lymphedema in her right arm and hand post breast cancer surgery. She recently saw a lymphedema specialist in California who suggested she use dicloxacillin rather than cloxacillin when she gets cellulitis in her fingers. She can get dicloxacillin in the US but not here. What is the difference between them as far a biologic activity ? Would it be reasonable to give her clox ??

Answer

Completely reasonable to give her cloxacillin. Give her a supply to have on hand. Tell her to take 1 gram Q6H as soon as she thinks is is starting. Back off to 500 mg QID when it settles and take it for 2 days after it is better and then stop. Often one can “abort” an episode with only 2-3 days of Rx. The only thing that high dose cloxacillin usually gives people is some loose stools that quickly improve with lower dose or cessation.

If she can access other isoxazolyl penicillins, the best is probably flucloxacillin (commonly used in Britain and parts of Europe). Dicloxacillin is a close second. It is a shame that they aren’t freely available in Canada but cloxacillin is still a “tried and true” anti staphylococcal agent.

Category: Skin and Soft Tissue Infections

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