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

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)

References

Authors

Bobak Zonnoor, Ross Donaldson, Neil Young, Claire, Daniel Ostermayer