Nafcillin
General
- Type: Penicillin, Beta-Lactamase-Resistant Penicillin
- Dosage Forms: IV
- Common Trade Names: Nafcil, Nallpen
Adult Dosing
Bacterial infections
- 0.5-2 g IV q4-6h
- Max: 12 g/day IV; Info: dose, duration varies with infection type, severity
Osteomyelitis
- 1-2 g IV q4h x4-6wk
- Max: 12 g/day
Bacterial Meningitis
- 100-200mg/kg/day IV divided q4-6h
- Max: 12 g/day
Endocarditis, Native valve
- 2 g IV q4h x4-6wk
- Max: 12 g/day; Info: give with gentamicin 1mg/kg IV q8h x3-5 days
Endocarditis, Prosthetic valve
- 2 g IV q4h x6wk
- Max: 12 g/day; Info: give with gentamicin 1-2mg/kg IV q8h x2wk and rifampin
Renal Dosing
- Consider decrease dose if concomitant hepatic impairment
Hepatic Dosing
- Consider decrease dose if concomitant renal impairment
Pediatric Dosing
Bacterial Infections
- 0-4 wk old, <1200 g
- Dose: 50mg/kg/day IV divided q12h
- <1 wk old, 1200-2000 g
- Dose: 50mg/kg/day IV divided q12h
- <1 wk old, >2000 g
- Dose: 75mg/kg/day IV divided q8h
- 1 wk old-1 mo, 1200-2000 g
- Dose: 75mg/kg/day IV divided q8h
- 1 wk old-1 mo, >2000 g
- Dose: 100mg/kg/day IV divided q6h
- 1 mo-16 yo
- Dose: 50-100mg/kg/day IV divided q6h if mild-mod. infection; 100-200mg/kg/day IV divided q4-6h if severe infection; Max: 12 g/day
Endocarditis, Native valve
- [1 mo-16 yo]
- Dose: 200mg/kg/day IV divided q4-6h x6wk; Max: 12 g/day; Info: give with gentamicin 3mg/kg/day IV divided q8h x3-5 days
Endocarditis, Prosthetic valve
- [1 mo-16 yo]
- Dose: 200mg/kg/day IV divided q4-6h x6wk or longer; Max: 12 g/day; Info: give with gentamicin 3mg/kg/day IV divided q8h x2wk and rifampin
Renal Dosing
- No adjustment unless concomitant hepatic impairment
- CrCl 10-29: 9-25mg/kg q6h if concomitant hepatic impairment; CrCl <10: 7.5-15mg/kg q6h if concomitant hepatic impairment
Hepatic Dosing
- Consider decrease dose if concomitant renal impairment
Safety
- Pregnancy: Class B
- Lactation: Probably Safe
Contraindications
- Hypersensitivity to drug/class.
- Anaphylactic reaction to beta-lactams
- Caution if non-anaphylactic hypersensitivity to beta-lactams
- Caution if hypersensitivity to multiple allergens
- Caution if asthma or history of asthma.
- Caution if recent antibiotic-associated colitis
- Caution if seizure disorder
- Caution if concomitant hepatic and renal impairment
- Caution if sodium restriction
Adverse Reactions
Serious
- Anaphylaxis
- Hypersensitivity reaction, immediate or delayed
- Serum sickness-like reaction
- Neutropenia
- Agranulocytosis
- Myelosuppression
- Clostridium difficile associated diarrhea
- Renal tubular necrosis
Common
- Diarrhea
- Nausea/Vomiting
- Utricaria
- Pruritus
- Rash
- Fever
- Eosinophilia
Pharmacology
- Half-life: 30-90 min
- Metabolism: Liver; CYP450:3A4 inducer
- Excretion: bile (primarily), urine
- Mechanism of Action: bactericidal; inhibits cell wall mucopeptide synthesis
Antibiotic Sensitivities[1]
Key
- S susceptible/sensitive (usually)
- I intermediate (variably susceptible/resistant)
- R resistant (or not effective clinically)
- S+ synergistic with cell wall antibiotics
- U sensitive for UTI only (non systemic infection)
- X1 no data
- X2 active in vitro, but not used clinically
- X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
- X4 active in vitro, but not clinically effective for strep pneumonia
See Also
References
- Sanford Guide to Antimicrobial Therapy 2014
This article is issued from
Wikem.
The text is licensed under Creative
Commons - Attribution - Sharealike.
Additional terms may apply for the media files.