Nafcillin, oxacillin, cloxacillin, and dicloxacillin are more resistant to bacterial p-lactamases than is penicillin G. Consequently, these antibiotics are effective against streptococci and most community-acquired penicilli-nase-producing staphylococci. Methicillin, which is no longer marketed in the United States, is another peni-cillinase-resistant antibiotic similar to nafcillin and oxacillin. For historical reasons, staphylococci resistant to oxacillin or nafcillin are labeled methicillin resistant. Many hospitals are reservoirs for MRSA and methi-cillin-resistant Staphylococcus epidermidis (MRSE). These nosocomial pathogens are resistant in vitro to all p-lactam antibiotics.
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