Nafcillin

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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]

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

References

  1. Sanford Guide to Antimicrobial Therapy 2014