Download Can a 2 gram dose of flucloxacillin be given as a slow intravenous

Medicines Q&As
Q&A 306.3
Can a 2 gram dose of flucloxacillin be given as a slow intravenous
injection?
Prepared by UK Medicines Information (UKMi) pharmacists for NHS healthcare professionals
Before using this Q&A, read the disclaimer at www.ukmi.nhs.uk/activities/medicinesQAs/default.asp
Date prepared: 7th March 2014
Background
Flucloxacillin is penicillin used primarily for the treatment of infections due to beta-lactamaseproducing staphylococci. Its indications include otitis externa; as an adjunct in pneumonia, impetigo,
cellulitis, osteomyelitis and in staphylococcal endocarditis (1, 2).
The usual routes of administration for flucloxacillin include oral, intramuscular injection, slow
intravenous injection and intravenous infusion (2-4).
The dosage of flucloxacillin depends on the severity and nature of the infection but when administered
intravenously, recommended doses are usually between 250 mg and 1 gram four times daily. These
doses may be doubled in severe infections (1, 3). Other sources advise 250 mg to 2 gram every 6
hours (2). Higher doses of up to 8 gram daily in 3 or 4 divided doses may be given for osteomyelitis;
in endocarditis a dose of 8 gram daily in 4 divided doses may be given to patients weighing up to 85
kg, and 12 gram daily in 6 divided doses may be used in those weighing more (1).
When administered intravenously it is recommended that flucloxacillin is given by slow intravenous
injection or by intravenous infusion (3, 4, 6).
Answer
The highest strength of flucloxacillin available on the UK market is 1 gram (3).
However, a 2 gram dose of flucloxacillin can be given as a slow intravenous injection. It is
recommended that each 1 gram vial is reconstituted with 15 to 20ml of water for injection. Once
reconstituted, each vial should be administered slowly over 3 to 4 minutes one after the other, i.e. 6 to
8 minutes in total for a 2 gram dose (3-7).
Because flucloxacillin is penicillin it is important to confirm the patient’s allergy status before
administering this antibiotic (2).
Summary




Flucloxacillin is penicillin used primarily for the treatment of infections due to beta-lactamaseproducing staphylococci.
The usual routes of administration for flucloxacillin include oral, intramuscular injection, slow
intravenous injection and intravenous infusion.
The dosage of flucloxacillin depends on the severity and nature of the infection but when
administered intravenously, recommended doses are usually between 250mg and 1g four times
daily. These doses may be doubled in severe infections. Some information sources advise 250mg
to 2 g every 6 hours.
A 2 gram dose of flucloxacillin can be administered as a slow intravenous injection over 6 to 8
minutes.
Available through NICE Evidence Search at www.evidence.nhs.uk
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Medicines Q&As
Limitations

This Q&A does not take into account the suitability of flucloxacillin in patients with concurrent
disease states, e.g. hepatic or renal failure.

The suitability of administering flucloxacillin as a slow intravenous injection to a patient should be
made on an individual basis.
References
1. Sweetman S, editor. Martindale: The Complete Drug Reference 37th ed. Flucloxacillin. Date of
revision of the text 06.12.11. Accessed 11.02.14 via www.medicinescomplete.com.
2. Martin J, editor. British National Formulary No 66 London: British Medical Association and The
Royal Pharmaceutical Society of Great Britain; February 2014. Accessed 07.03.14 via
www.bnf.org.uk.
3. Summary of Product Characteristics. Flucloxacillin 1g Powder for Solution for Injection or Infusion
(Wockhardt
UK
Ltd).
Date
last
updated
15.08.13.
Accessed
07.02.14
via
http://www.emc.medicines.org.uk.
4. Klasco R, editor. DRUGDEX® System electronic version. Thomson Micromedex, Greenwood
Village, Colorado, USA. FLOXACILLIN, Drugdex evaluation. Date of revision of text 29.10.13.
Accessed 11.02.14 via http://www.thomsonhc.com.
5. Trissel A. Handbook on Injectable Drugs. Floxacillin Sodium. Accessed 11.02.14 via
www.medicinescomplete.com.
6. Pharmacy Department. University College London Hospitals NHS Foundation Trust. Injectable
Medicines Administration Guide. 3rd ed. Wiley-Blackwell Publishing; 2010, p. 170.
7. Personal Communication. Wockhardt UK Ltd. Contacted 28.02.14
Quality Assurance
Prepared by
Updated by Sarah Cavanagh, East Anglia Medicines Information. Original Author Mark Cheeseman
Date Prepared
7 March 2014
Checked by
17 March Katie Smith, East Anglia Medicines Information Service
Date of check
March 2014
Search strategy
References
 Embase (“exp FLUCLOXACILLIN/ AND exp BOLUS INJECTION/”; “exp FLUCLOXACILLIN/ AND
exp INTRAVENOUS DRUG ADMINISTRATION/ AND exp DRUG MEGADOSE/”; “
 Medline (“exp FLOXACILLIN/ AND exp INJECTIONS, INTRAVENOUS” ; “exp FLOXACILLIN/
AND exp WATER-ELECTROLYTE BALANCE/” )
 In-house database
 Mandell GL, Bennett JE, Dolin R, editors. Mandell, Douglas, and Bennett’s Principles and
Practice of Infectious Diseases. 7th ed. USA: Churchill Livingstone Elsevier; 2010.
 Manufacturer (Wockhardt UK Ltd, Drug Safety and Information department). Contacted 02.03.14.
 NHS Evidence ("Flucloxacillin" )
 IDISWeb ("floxacillin 8121613" AND "adm parent intravenous 66).
Available through NICE Evidence Search at www.evidence.nhs.uk
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