I’m “Di”ing to know more, back to biotics

Insert a Jack Nicholson in the Shining “I’m back”. Or don’t, either way I am, not from being gone but from writing about antibiotics, and bringing a post on dicloxacillin. What is that you ask? No. I’m kidding, you don’t ask but I’m feeling you anyways. 

Truth bomb: it’s a penicillin, if you didn’t notice. Truth bomb part deux: therefore it be a beta-lactam. Yes it be and it do. What does it do? Mess up the cell wall by binding to PBP like the Korean Zombie messed up Dustin Poirier. But unlike the Korean Zombie, it has a narrow spectrum of activity against staph infections. It is recommended for use only on culture confirmed beta-lactase producing mild to moderate infections. Which, to take a minute, seems very subjective. Like mild and moderate salsa. My white guy tongue thinks moderate is fire and mild is almost too far. As I write that, I did find out how they differ. Mild is superficial and limited, moderate is deeper, and severe is metastatic, systemic, and effects metabolic processes. OK. Rant over before it started. 

Why bother with narrow? For those of us in the infancy of our healthcare careers, using the smallest bullet for the job has a lesser risk of collateral damage. Whereas a broad spectrum antibiotic, like a carbapenem, comes in like a wrecking ball as Eric Church or Miley Cyrus would say. Eric is better by the way. While any antibiotic has the possibility to disrupt one's microbiome, the broader the spectrum, the more damage. You still need to be aware of diarrhea, nausea, and rash as well as looking out for CDAD, SJS, superinfection, and also liver damage. Mmmmmm liver. Thinly sliced with onion and butter. 

Want to know something fun? There is in vitro activity of thioridazine and dicloxacillin against vancomycin intermediate staph aureus (VISA). Pretty cool, an antipsychotic and an antibiotic teaming up to fight crime. It warms where my heart should be. Of course, it didn't work in pigs. It is up to you what species I am talking about. But why? My favorite two words. In my layperson speak, it looks like the thioridazine does some ion stuff that effects the cell wall stuff allowing the dicloxacillin to do its stuff and stuff. Got that? What about the side effects of the thioridazine? Antipsychotics are known for their side effects. Is that the same for a (hopefully) short course of antibiotics? Do I need to worry about EPS when I get treated for cellulitis? Who knows? I don't want to find out but it would be cool if my crazy pills helped whatever antibiotic I may need in the future. Let's say that it will help, it makes me fell better. 

It is normally given between 125-500mg every 6 hours by mouth. It is a CYP3A4 inducer so drugs like methotrexate should be more closely monitored (if it wasn't already). And that is where I will end this. I sit here at a hockey game watching kids skate into each other and praying that no one gets hurt so that I can work without working. Remember to share this and my podcast on iTunes and Spotify. I suppose I should plug my Twitter too @kruegerjr4 and my Instagram I have yet to use at occasionally_preposterous. Feed my ego and leave good reviews. But also merciless criticism is also accepted and probably much more warranted than praise. Have an excellent day, week, weekend, century, or whatever you are on the brink of. Love you all. 

References
Antibiotic Resistance and the MRSA Problem from Microbiology Spectrum 2019 by Vestergaard et al.

Combination of thioridazine and dicloxacillin as a possible treatment strategy of staphylococci in New Microbiology 2017 by Rasmussen et al.

Image of staph plushie from GIANTMicrobes.com

Safety and pharmacokinetics of dicloxacillin in healthy Chinese volunteers following single and multiple oral doses in Drug Design, Development, and Therapy by Wu et al. in 2015.

Systemic thioridazine in combination with dicloxacillin against early aortic graft infections caused by Staphylococcus aureus in a porcine model: In vivo results do not reproduce the in vitro synergistic activity by Stenger et al. in 2017 in PLoS One.

2012 Infectious Diseases Society of America Clinical Practice Guideline for the Diagnosis and Treatment of Diabetic Foot Infections from CID in 2012 (who knew?) by Lipsky et al.


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