Nafcillin

Revision as of 02:31, 25 May 2014 by Bobzmac (talk | contribs) (Serious)

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 w/ infection type, severity

Osteomyelitis

  • 1-2 g IV q4h x4-6wk
  • Max: 12 g/day

Bacterial Meningitis

  • 100-200 mg/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 w/ gentamicin 1 mg/kg IV q8h x3-5 days

Endocarditis, Prosthetic valve

  • 2 g IV q4h x6wk
  • Max: 12 g/day; Info: give w/ gentamicin 1-2 mg/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: 50 mg/kg/day IV divided q12h
  • <1 wk old, 1200-2000 g
  • Dose: 50 mg/kg/day IV divided q12h
  • <1 wk old, >2000 g
  • Dose: 75 mg/kg/day IV divided q8h
  • 1 wk old-1 mo, 1200-2000 g
  • Dose: 75 mg/kg/day IV divided q8h
  • 1 wk old-1 mo, >2000 g
  • Dose: 100 mg/kg/day IV divided q6h
  • 1 mo-16 yo
  • Dose: 50-100 mg/kg/day IV divided q6h if mild-mod. infection; 100-200 mg/kg/day IV divided q4-6h if severe infection; Max: 12 g/day

Endocarditis, Native valve

  • [1 mo-16 yo]
  • Dose: 200 mg/kg/day IV divided q4-6h x6wk; Max: 12 g/day; Info: give w/ gentamicin 3 mg/kg/day IV divided q8h x3-5 days

Endocarditis, Prosthetic valve

  • [1 mo-16 yo]
  • Dose: 200 mg/kg/day IV divided q4-6h x6wk or longer; Max: 12 g/day; Info: give w/ gentamicin 3 mg/kg/day IV divided q8h x2wk and rifampin

Renal Dosing

  • No adjustment unless concomitant hepatic impairment
  • CrCl 10-29: 9-25 mg/kg q6h if concomitant hepatic impairment; CrCl <10: 7.5-15 mg/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 rxn 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 abx-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

Metabolism: liver; CYP450: 3A4 inducer

Excretion: bile primarily, urine; Half-life: 30-90min

Subclass: Penicillins, Penicillinase-resistant

Mechanism of Action bactericidal; inhibits cell wall mucopeptide synthesis


Pharmacology

  • Half-life: 30-90 min
  • Metabolism: Liver; CYP450:3A4 inducer
  • Excretion: bile (primarily), urine
  • Mechanism of Action: bactericidal; inhibits cell wall mucopeptide synthesis


See Also

Source

Epocrates