Nafcillin

Nafcillin is used for: Severe Infections, Susceptible Infections, Staphylococcal Endocarditis, Bursitis septic

Susceptible Infections 500 mg IV/IM q4-6hr Severe Infections 1 g IV/IM q4hr Staphylococcal Endocarditis 2 g IV q4hr for 4-6 weeks; may be longer and may add rifampin and gentamicin if prosthetics present Bursitis septic 2 g IV q4hr

IV/IM Preparation IM/IV: reconstitute 1-2 g of drug w/ 3.4- 6.8 mL SWI/BWI/NS to 250 mg/mL IV inj: further dilute w/ 15-30 mL SWI/NS IV infusion: further dilute w/ IV solution according to Mfr's directions Bulk Packages: Reconstitute 10 g of drug w/ 93 mL SWI/NS to 100 mg/mL THEN further dilute before administration Not for direct IV injection IV/IM Administration IM: deep into large muscle IV inj: slowly over 5-10 min IV infusion: over at least 30-60 min

A history of a hypersensitivity (anaphylactic) reaction to any penicillin Solutions containing dextrose in patients with known allergy to corn or corn products

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 If clostridium difficile associated diarrhea (CDAD) suspected or confirmed, may need to discontinue ongoing antibiotic use not directed against C. difficile; appropriate fluid and electrolyte management, protein supplementation, antibiotic treatment of C. difficile, and surgical evaluation should be instituted as clinically indicated 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

Side effects of Nafcillin : 1-10% Hypersensitivity Neutropenia Interstitial nephritis Possible hypokalemia <1% Neurotoxicity (high doses) Pseudomembranous colitis Phlebitis (oxacillin preferred in peds)

Inhibit synthesis of bacterial cell wall synthesis, which results in bactericidal activity