Oxacillin-induced tissue necrosis

OBJECTIVE: TO report a case of oxacillin-induced tissue necrosis in which r ecommended concentration guidelines for dilution and administration were us ed. Oxacillin concentration data, potential risk factors, and treatment opt ions for extravasation injuries are also briefly reviewed. CASE SUMMARY: Oxacillin was infused peripherally by infusion pump in a 79-y ear-old white woman as prophylactic antibiotic coverage for permanent pacem aker placement. Oxacillin extravasation occurred after the second postopera tive dose. A dime-sized area of necrosis was noted at the heparin-lock inse rtion site. DISCUSSION: Only one case of oxacillin-induced necrosis has been reported. The degree of damage and concentration of drug used were not specifically d escribed. Concentration may play a role in the appearance or absence of tis sue damage after an antibiotic extravasation and should be taken into consi deration when evaluating a drug's tissue toxicity potential. CONCLUSIONS: The potential exists for oxacillin 50 mg/mL to cause tissue da mage in humans if an extravasation occurs. This reaction may be avoided wit h use of a less-concentrated preparation, avoidance of infusion pump admini stration, and identification of high-risk patients.