Nafcillin

General

• Type: Penicillin, Beta-Lactamase-Resistant Penicillin
• Dosage Forms: IV
• Common Trade Names: Nafcil, Nallpen

Adult Dosing

Indications by Disease

Disease	Dose	Context
Endocarditis	2g IV six times daily	Native Valve Endocarditis
Suppurative parotitis	2g IV six times daily	Inpatient

Pediatric Dosing

Indications by Disease

Disease	Dose	Context
Endocarditis	50mg/kg IV q6hrs (max 2g/dose)	Pediatric MSSA
Osteomyelitis	50 mg/kg IV four times daily	Sickle Cell Disease
Suppurative parotitis	50mg/kg IV four times daily	Inpatient

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

Group	Organism	Sensitivity
Gram Positive	Strep. Group A, B, C, G	S
	Strep. Pneumoniae	S
	Viridans strep	I
	Strep. anginosus gp	S
	Enterococcus faecalis	R
	Enterococcus faecium	R
	MSSA	S
	MRSA	R
	CA-MRSA	R
	Staph. Epidermidis	S
	C. jeikeium	R
	L. monocytogenes	R
Gram Negatives	N. gonorrhoeae	R
	N. meningitidis	R
	Moraxella catarrhalis	R
	H. influenzae	R
	E. coli	R
	Klebsiella sp	R
	E. coli/Klebsiella ESBL+	R
	E coli/Klebsiella KPC+	R
	Enterobacter sp, AmpC neg	R
	Enterobacter sp, AmpC pos	R
	Serratia sp	R
	Serratia marcescens	X1
	Salmonella sp	R
	Shigella sp	R
	Proteus mirabilis	R
	Proteus vulgaris	R
	Providencia sp.	R
	Morganella sp.	R
	Citrobacter freundii	R
	Citrobacter diversus	R
	Citrobacter sp.	R
	Aeromonas sp	R
	Acinetobacter sp.	R
	Pseudomonas aeruginosa	R
	Burkholderia cepacia	R
	Stenotrophomonas maltophilia	R
	Yersinia enterocolitica	R
	Francisella tularensis	X1
	Brucella sp.	X1
	Legionella sp.	R
	Pasteurella multocida	R
	Haemophilus ducreyi	X1
	Vibrio vulnificus	X1
Misc	Chlamydophila sp	R
	Mycoplasm pneumoniae	R
	Rickettsia sp	X1
	Mycobacterium avium	X1
Anaerobes	Actinomyces	R
	Bacteroides fragilis	R
	Prevotella melaninogenica	R
	Clostridium difficile	X1
	Clostridium (not difficile)	X1
	Fusobacterium necrophorum	X1
	Peptostreptococcus sp.	S

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

• Antibiotics (Main)