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Clinical medicine profile

Cloxacillin

Beta-lactam antibiotic — penicillin

POM
Evidence state Source not available Reviewed 14 Aug 2026
Route
ORAL / PARENTERAL (agent-dependent)
Schedule
POM
ATC
Not assigned
PPB status
registered
Patient advice Check interactions
Verification required

This profile needs source confirmation

A traceable source link is not attached to this profile. Confirm prescribing decisions against the current SmPC and Kenya STG/EML.

01 Risk first

Safety essentials

The information most likely to change a prescribing or dispensing decision.

Contraindications

  • History of serious immediate hypersensitivity (e.g. anaphylaxis, angioedema, urticaria) to any penicillin.
  • Caution with prior severe cephalosporin reaction (cross-reactivity risk).
  • Avoid in infectious mononucleosis if using aminopenicillins (rash risk).

Precautions

  • Risk of kernicterus in jaundiced neonates when high doses are given parenterally.
  • Serious and occasionally fatal immediate hyper- sensitivity reactions may occur
02 Point of care

Dosing matrix

Population and organ-function guidance, shown together for faster comparison.

Adult

Orally: Adult; 500mg QID [orally]. Children; 25-50mg/kg/day. I.M: Adult; 250mg every 4-6 hours. I.V inj or inf. 500mg every 4-6 hours. Children; 25-50mg/kg/day. In severe case doses may be doubled.

Paediatric

See label paediatric section if present; otherwise use paediatric formulary — do not extrapolate adult doses.

Renal

Renal excretion dominant — reduce dose or extend interval in significant renal impairment; risk of accumulation and seizures at high levels.

  • CrCl 0–120: Confirm renal dosing in product SmPC / primary label.
Hepatic

Low intrinsic hepatotoxicity; cholestatic hepatitis rare (notably flucloxacillin/co-amoxiclav patterns for related agents).

03 Clinical use

Use, effects & interactions

Indications

  • Infections, especially those due to penicillinase-producing staphylococci.
  • Clinical selection for Cloxacillin should follow culture results where relevant, Kenya STG/EML recommendations, and the current product SmPC.
  • Class context: Beta-lactam antibiotic — penicillin.
  • Confirm site-specific dose, duration and monitoring before prescribing.

Adverse effects

  • Allergic reactions that include skin rashes and immediate anaphylaxis
  • sterile inflammationca at the site of intramuscular injec- tion
  • peripheral nerve pain and dysfunction
  • Nephropathy manifested as interstitial nephritis has been reported neutropenia and thrombocytopenia

Drug interactions

Open multi-drug checker ↗
  • For professionals: select agent by suspected pathogen and local resistance.
  • Natural penicillins remain first-line for many streptococcal infections when susceptibility expected.
  • Do not use penicillin alone for beta-lactamase-producing staphylococci.
  • Document allergy phenotype (immediate vs delayed).
  • De-escalate once cultures allow.
04 Pharmacology

Mechanism & disposition

Inhibits synthesis of bacterial cell wall, causing cell death, hence bactericidal.

Bind PBPsBlock wall cross-linkingOsmotic lysisBactericidal
Read complete mechanism

Inhibits synthesis of bacterial cell wall, causing cell death, hence bactericidal. Penicillins bind penicillin-binding proteins (PBPs) and inhibit the final transpeptidation step of peptidoglycan synthesis, weakening the bacterial cell wall. Osmotic lysis follows; activity is bactericidal against susceptible organisms in the growth phase. Spectrum and beta-lactamase stability vary by agent (narrow natural penicillins vs aminopenicillins vs antipseudomonal/anti-staphylococcal agents).

Onset

Within 1 hour (oral); faster IV

Duration

4–8 hours typical (agent/formulation dependent)

Route

ORAL / PARENTERAL (agent-dependent)

Elimination

is predominantly renal (glomerular filtration and tubular secretion). Dose adjustment is often required in severe renal impairment. Probenecid reduces tubular secretion and prolongs levels.

Half-life

differ by agent and salt/ester. Most penicillins distribute widely into extracellular fluid; CSF penetration is poor unless meninges are inflamed.

05 Special populations

Pregnancy, lactation & diet

Pregnancy

Penicillins are generally considered compatible in pregnancy when clearly indicated (decades of clinical use). Prefer agents with the best safety record for the indication; confirm current SmPC.

Lactation

Usually compatible with breastfeeding; small amounts excreted in milk. Monitor infant for diarrhoea, thrush or rash.

06 Kenya market

Brands & loaded prices

FromKES 633
MedianKES 633
Listings2
BrandManufacturerPackObserved price
ExcipientsQ.S. Afya Index / Retail Reference caps 250mg 100's KES 633.00afya_index_book
Floxapen Afya Index / Retail Reference caps 250mg 100's KES 4,242.00afya_index_book
07 Provenance

Sources & review state

Primary sourceLocal active-ingredient clinical extract; Professional class pharmacology (Beta-lactam antibiotic — penicillin)
Last reviewed14 Aug 2026
EvidenceSource not available

Decision support only. Confirm patient-specific decisions against the current product SmPC, Kenya STG/EML, and professional judgement.