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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/04/20 04:23:38」(JST)
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| Systematic (IUPAC) name | |
|---|---|
| (2S,5R,6R)-6-({[3-(2-chloro-5-fluorophenyl)-5-methylisoxazole-4-yl]carbonyl}amino)-3,3-dimethyl-7-oxo-4-thia-1-azabicyclo[3.2.0]heptane-2-carboxylic acid | |
| Clinical data | |
| AHFS/Drugs.com | Micromedex Detailed Consumer Information |
| Pregnancy cat. | B1 (AU) |
| Legal status | Prescription Only (S4) (AU) POM (UK) |
| Routes | Oral, IM, IV, intrapleural, intraarticular |
| Pharmacokinetic data | |
| Bioavailability | 50–70% |
| Metabolism | Hepatic |
| Half-life | 0.75–1 hour |
| Excretion | Renal |
| Identifiers | |
| CAS number | 5250-39-5 Y |
| ATC code | J01CF05 QJ51CF05 |
| PubChem | CID 21319 |
| DrugBank | DB00301 |
| ChemSpider | 20037 Y |
| UNII | 43B2M34G2V Y |
| KEGG | D04196 Y |
| ChEBI | CHEBI:5098 Y |
| ChEMBL | CHEMBL222645 Y |
| Chemical data | |
| Formula | C19H17ClFN3O5S |
| Mol. mass | 453.87 g/mol |
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| Y (what is this?) (verify) |
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Flucloxacillin (INN) or floxacillin (USAN) is a narrow-spectrum beta-lactam antibiotic of the penicillin class. It is used to treat infections caused by susceptible Gram-positive bacteria. Unlike other penicillins, flucloxacillin has activity against beta-lactamase-producing organisms such as Staphylococcus aureus[1] as it is beta-lactamase stable. However, it is ineffective against MRSA[citation needed]. It is very similar to dicloxacillin and these two agents are considered interchangeable. Flucloxacillin is available under a variety of trade names including Floxapen (Beecham, now GSK), Flopen (CSL), Staphylex (Alphapharm), and Softapen (Rephco Pharmaceuticals Limited).
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Overview of common uses
It is most commonly used to treat infections such as:
Chest, ear, nose and throat infections (eg tonsillitis, sinusitis, pneumonia);
Skin and soft tissue infections (eg boils, burns, wounds, abscesses, infected eczema, infected acne);
Other infections including those of the heart (endocarditis), bones and joints (osteomyelitis), membranes of the brain (meningitis), guts (enteritis), blood (septicaemia), and the kidney, bladder or urethra (the tube which carries urine from the bladder).
Flucloxacillin can also be used to prevent infections during major surgical procedures, particularly in heart or orthopedic surgery.
Mode of action
Main article: Beta-lactam antibiotic
Like other β-lactam antibiotics, flucloxacillin (Fluclox) acts by inhibiting the synthesis of bacterial cell walls. It inhibits cross-linkage between the linear peptidoglycan polymer chains that make up a major component of the cell wall of Gram-positive bacteria.
Medicinal chemistry
Flucloxacillin is insensitive to beta-lactamase (also known as penicillinase) enzymes secreted by many penicillin-resistant bacteria. The presence of the isoxazolyl group on the side-chain of the penicillin nucleus facilitates the β-lactamase resistance, since they are relatively intolerant of side-chain steric hindrance. Thus, it is able to bind to penicillin-binding proteins (PBPs) and inhibit peptidoglycan crosslinking, but is not bound by or inactivated by β-lactamases.
Clinical use
Flucloxacillin is more acid-stable than many other penicillins and can be given orally, in addition to parenteral routes. However, like methicillin, it is less potent than benzylpenicillin against non-β-lactamase-producing Gram-positive bacteria.
Flucloxacillin has similar pharmacokinetics, antibacterial activity, and indications to dicloxacillin, and the two agents are considered interchangeable. It is believed to have higher incidence of severe hepatic adverse effects than dicloxacillin, but a lower incidence of renal adverse effects.[2]
Available forms
Flucloxacillin is commercially available as the sodium salt flucloxacillin sodium, in capsules (250 or 500 mg), oral suspensions (125 mg/5 mL or 250 mg/5 mL), and injections (powder for reconstitution, 250, 500 and 1000 mg per vial).
Indications
Flucloxacillin is indicated for the treatment of infections caused by susceptible bacteria. Specific approved indications include:[2][3]
- Staphylococcal skin infections and cellulitis – including impetigo, otitis externa, folliculitis, boils, carbuncles, and mastitis
- Pneumonia (adjunct)
- Osteomyelitis, septic arthritis
- Septicaemia
- Empirical treatment for endocarditis
- Surgical prophylaxis
Flucloxacillin has relatively poor activity against non-β-lactamase-producing bacteria including Streptococcus pyogenes. Therefore, empirical therapy for significant cellulitis often involves dual-therapy to cover both staphylococci and streptococci, using either penicillin or ampicillin in addition to flucloxacillin. The latter is available as a standardised combination preparation co-fluampicil (flucloxacillin+ampicillin).
Precautions/contraindications
Flucloxacillin is contraindicated in those with a previous history of allergy to penicillins, cephalosporins, or carbapenems. It should also not be used in the eye, or administered to those with a history of cholestatic hepatitis associated with the use of dicloxacillin or flucloxacillin.[2]
It should be used with caution in the elderly; patients with renal impairment, where a reduced dose is required; and those with hepatic impairment, due to the risk of cholestatic hepatitis.[2]
Adverse effects
Common adverse drug reactions (ADRs) associated with the use of flucloxacillin include: diarrhoea, nausea, rash, urticaria, pain and inflammation at injection site, superinfection (including candidiasis), allergy, and transient increases in liver enzymes and bilirubin.[2]
Rarely, cholestatic jaundice (also referred to as cholestatic hepatitis) has been associated with flucloxacillin therapy. The reaction may occur up to several weeks after treatment has stopped, and takes weeks to resolve. The estimated incidence is 1 in 15,000 exposures, and is more frequent in people >55 years, females, and those with treatment longer than 2 weeks.[2][3]
Resistance
Despite flucloxacillin's being insensitive to beta-lactamases, some organisms have developed resistance to it and other narrow-spectrum β-lactam antibiotics including methicillin. Such organisms include methicillin-resistant Staphylococcus aureus (MRSA). MRSA has developed resistance to flucloxacillin and other penicillins by having an altered penicillin-binding protein.
See also
- Beta-lactam antibiotic
- Dicloxacillin
References
- ^ Sutherland R, Croydon EA, Rolinson GN (November 1970). "Flucloxacillin, a new isoxazolyl penicillin, compared with oxacillin, cloxacillin, and dicloxacillin". Br Med J 4 (5733): 455–60. doi:10.1136/bmj.4.5733.455. PMC 1820086. PMID 5481218.
- ^ a b c d e f Rossi S, editor. Australian Medicines Handbook 2006. Adelaide: Australian Medicines Handbook; 2006.
- ^ a b Joint Formulary Committee. British National Formulary, 50th edition. London: British Medical Association and Royal Pharmaceutical Society of Great Britain; 2005.
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English Journal
- Interaction of flucloxacillin and quinidine.
- Comuth WJ, Comuth JA, Hauer RN, Malingré MM.
- European journal of clinical pharmacology.Eur J Clin Pharmacol.2012 May;68(5):891-3. Epub 2011 Dec 28.
- PMID 22203424
- Fever and haemoptysis in an injecting drug user.
- Luther V, Townell J, Rahman H, Loong CY.SourceWhittington Hospital, London N19 5NF, UK. vishal_luther@yahoo.co.uk
- BMJ (Clinical research ed.).BMJ.2012 Mar 13;344:e1568. doi: 10.1136/bmj.e1568.
- PMID 22415952
Related Links
- ... floxacillin sensitive, from three of three bottles. Endocarditis due to Staphylococcus aureus after minor dog bite. (Case ... by Bradshaw, Steven E. / Southern Medical Journal After treatment with topical bacitracin, floxacillin by ...
- Floxacillin information including symptoms, causes, diseases, symptoms, treatments, and other medical and health issues. ... Introduction: Floxacillin Description of Floxacillin Floxacillin: Antibiotic analog of CLOXACILLIN. Source: Diseases Database
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| リンク元 | 「flucloxacillin」「フロキサシリン」 |
「flucloxacillin」
- (βラクタマーゼ抵抗性ペニシリン系抗生物質)ルクロキサシリン
「フロキサシリン」
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- floxacillin
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