Nafcillin

DEA Class; Rx

Common Brand Names; Nafcil, Nallpen

  • Penicillins, Penicillinase-Resistant

Oral semisynthetic isoxazolyl antistaphylococcal penicillin. Most active of the isoxazolyl antistaphylococcal penicillins. Stable against penicillinase and active against many of the penicillinase-producing strains of Staphylococcus aureus. Clinical uses include skin and soft-tissue, bone and joint, respiratory tract, and urinary tract infections.

Indicated for the treatment of mastitis.

For the treatment of skin and skin structure infections, including impetigo, cellulitis, erysipelas, animal bite wounds, and diabetic foot ulcer.
For the treatment of peritoneal dialysis catheter-related infection.

A history of a hypersensitivity (anaphylactic) reaction to any penicillin

Solutions containing dextrose in patients with known allergy to corn or corn products

  • Hypersensitivity
  • Neutropenia
  • Interstitial nephritis
  • Possible hypokalemia
  • Neurotoxicity (high doses)
  • Pseudomembranous colitis
  • Phlebitis (oxacillin preferred in peds)

Evaluate renal, hepatic, hematologic systems periodically during prolonged treatment

Serious and occasionally fatal hypersensitivity (anaphylactic) reactions reported; reactions are more likely to occur in individuals with history of penicillin hypersensitivity and/or a history of sensitivity to multiple allergens; inquire about previous hypersensitivity reactions to penicillins, cephalosporins, or other allergens before initiating therapy; if allergic reaction occurs, discontinue treatment and institute appropriate therapy

Use with caution in patients with histories of significant allergies and/or asthma; whenever allergic reactions occur, withdraw penicillin unless, in the opinion of the physician, the condition being treated is life-threatening and amenable only to penicillin therapy

Liver/biliary tract is primary route of nafcillin clearance; exercise caution when patients with concomitant hepatic insufficiency and renal dysfunction are treated with this drug

Prescribing the antibiotic in the absence of a proven or strongly suspected bacterial infection or a prophylactic indication is unlikely to provide benefit to patient and increases risk of development of drug-resistant bacteria

The use of antibiotics may result in overgrowth of nonsusceptible organisms; if new infections due to bacteria or fungi occur, discontinue drug and take appropriate measures

To optimize therapy, determine causative organisms and susceptibility; > 10 d treatment to eliminate infection and prevent sequelae (eg, endocarditis, rheumatic fever); take cultures after treatment to confirm that infection is eradicated

Elevation of liver transaminases and/or cholestasis may occur, specifically with administration of high doses

Urinalysis, serum blood urea nitrogen, and creatinine determinations should be performed at baseline and periodically during therapy; serum bilirubin, aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase, and gamma-glutamyl transferase should be obtained at baseline and periodically during therapy, especially when using high nafcillin doses; in patients with worsening hepatic

Renal tubular damage and interstitial nephritis associated with administration of nafcillin; manifestations of nephrotoxicity are hematuria, proteinuria, and acute kidney injury, and may be associated with rash, fever, and eosinophilia; majority of cases resolve upon discontinuation of nafcillin; some patients, may require dialysis treatment and may develop permanent renal damage

Pregnancy Category: B

Lactation: Excreted into breast milk; use caution

Adults

1 g/day PO per FDA-approved labeling; however, doses up to 2 g/day PO have been used off-label.

Geriatric

1 g/day PO per FDA-approved labeling; however, doses up to 2 g/day PO have been used off-label.

Adolescents

25 mg/kg/day PO (Max: 1 g/day) per FDA-approved labeling; however, doses up to 50 mg/kg/day PO (Max: 2 g/day) have been used off-label.

Children

25 mg/kg/day PO (Max: 1 g/day) per FDA-approved labeling; however, doses up to 50 mg/kg/day PO (Max: 2 g/day) have been used off-label.

Nafcillin

injectable solution

  • 20mg/mL
  • 2g/100mL

powder for injection

  • 1g
  • 2g
  • 10g

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