Is it okay to give 2 grams of flucloxacillin (Flucloxacillin)?

From the Guidelines

It is not recommended to give 2g of flucloxacillin without considering the patient's specific details, including age, weight, renal function, indication for treatment, and medical history, as the standard dosage is 12 g/day i.v. in 4-6 doses for infective endocarditis due to Staphylococcus spp. 1. When treating infective endocarditis due to Staphylococcus spp., the dosage of flucloxacillin is crucial to ensure effective treatment and minimize the risk of adverse effects.

• The recommended dosage of flucloxacillin for adults is 12 g/day i.v. in 4-6 doses, with a duration of 4-6 weeks 1.
• For pediatric patients, the dosage is 200 mg/kg/day i.v. in 4-6 equally divided doses 1.
• It is essential to note that the dosage may need to be adjusted for patients with kidney impairment, the elderly, or children.
• Flucloxacillin should be administered on an empty stomach, 30-60 minutes before meals or 2 hours after, to maximize absorption.
• A healthcare provider should always determine the appropriate dosage based on the specific clinical situation, taking into account the patient's medical history, age, weight, and renal function.
• The use of gentamicin in combination with flucloxacillin is optional, as its clinical benefit has not been formally demonstrated, and it is associated with increased toxicity 1.

From the Research

Dosage of Flucloxacillin

• The provided studies do not mention the dosage of flucloxacillin, specifically 2g, and its safety or efficacy.
• The studies primarily focus on the comparison of vancomycin and linezolid in treating Gram-positive infections, including methicillin-resistant Staphylococcus aureus (MRSA) 2, 3, 4, 5, 6.
• There is no direct evidence to support or refute the use of 2g of flucloxacillin based on the provided studies.

Renal Impairment and Antibiotic Use

• The studies suggest that vancomycin may be nephrotoxic, especially in patients with renal impairment 2, 3, 4.
• Linezolid may be a suitable alternative for patients with renal impairment due to its lower risk of nephrotoxicity 5, 6.
• However, the dosage of flucloxacillin is not discussed in the context of renal impairment or its potential nephrotoxic effects.

Conclusion on Available Evidence

• There are no research papers provided that directly address the safety or efficacy of giving 2g of flucloxacillin.
• The available evidence focuses on the comparison of vancomycin and linezolid, and does not provide guidance on the use of flucloxacillin 2, 3, 4, 5, 6.