E-DRUG: cloxacillin, dicloxacillin or flucloxacillin?
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[A review of a draft Essential Medicines List in an East African country resulted in a "parking list" of unanswered questions. Can E-druggers help? We will publish a few practical questions in the coming days; the answers might also help other countries. WB]
dear E-druggers
An African Essential Medicines list contains both oral and injectable forms of cloxacillin and flucloxacillin. Is there any reason to have both or prefer one above the other?
And what about dicloxacillin?
Martindale says dicloxacillin and flucloxacillin are absorbed twice as good as cloxacillin; is this effect clinically significant?
They are absorbed as cloxacillin, so can one assume that the efficacy and spectrum of these molecules are the same?
The new 14th WHO EML mentions as essential: "cloxacillin capsule, 500 mg, 1 g (as sodium salt); powder for oral solution, 125 mg (as sodium salt)/5 ml; powder for injection, 500 mg (as sodium salt) in vial"
There is a square block in front of cloxacillin. According to WHO:
" The square box symbol () is primarily intended to indicate similar clinical performance within a pharmacological class. The listed medicine should be the example of the class for which there is the best evidence for effectiveness and safety. In some cases, this may be the first medicine that is licensed for marketing; in other instances, subsequently licensed compounds may be safer or more effective. Where there is no difference in terms of efficacy and safety data, the listed medicine should be the one that is generally available at the lowest price, based on international drug price information sources. Therapeutic equivalence is only indicated on the basis of reviews of efficacy and safety and when consistent with WHO clinical guidelines. National lists should not use a similar symbol and should be specific in their final selection, which would depend on local availability and price."
Apart from price, is there any reason to prefer a molecule, and drop the other?
Wilbert
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Dr Wilbert Bannenberg, Public Health Consultant
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