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April 11, 1977

9. Penicillinase-Resistant Penicillins: Veterans Administration Ad Hoc Interdisciplinary Advisory Committee on Antimicrobial Drug Usage

JAMA. 1977;237(15):1605-1606. doi:10.1001/jama.1977.03270420073024

THE PENICILLINASE-RESISTANT penicillins are effective, highly specific agents for treatment of staphylococcal infections. Accordingly, there must be strong evidence that the patient does have staphylococcal infection and that it is sensitive to this class of drugs. Parenteral therapy with these drugs (methicillin sodium, oxacillin sodium, and nafcillin sodium) is particularly expensive and should be prescribed for a clearly justifiable reason. Oral agents include oxacillin sodium, nafcillin sodium, cloxacillin sodium monohydrate, and dicloxacillin sodium monohydrate. Probenecid may be used concomitantly to increase blood levels at low cost. Metastasis is common in these infections. Therefore, therapy should continue for at least 14 days. The principal indication for use of these penicillins is staphylococcal infections; however these agents are effective against other Gram-positive cocci when given in full doses. However, the only justification for their use in these conditions would be if, prior to therapy, the physician could not be certain that he