Nafcillin: Difference between revisions
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===Bacterial infections=== | ===Bacterial infections=== | ||
*0.5-2 g IV q4-6h | *0.5-2 g IV q4-6h | ||
*Max: 12 g/day IV; Info: dose, duration varies | *Max: 12 g/day IV; Info: dose, duration varies with infection type, severity | ||
===Osteomyelitis=== | ===[[Osteomyelitis]]=== | ||
*1-2 g IV q4h x4-6wk | *1-2 g IV q4h x4-6wk | ||
*Max: 12 g/day | *Max: 12 g/day | ||
===Bacterial Meningitis=== | ===Bacterial [[Meningitis]]=== | ||
*100- | *100-200mg/kg/day IV divided q4-6h | ||
*Max: 12 g/day | *Max: 12 g/day | ||
===Endocarditis, Native valve=== | ===[[Endocarditis]], Native valve=== | ||
*2 g IV q4h x4-6wk | *2 g IV q4h x4-6wk | ||
*Max: 12 g/day; Info: give | *Max: 12 g/day; Info: give with [[gentamicin]] 1mg/kg IV q8h x3-5 days | ||
===Endocarditis, Prosthetic valve=== | ===[[Endocarditis]], Prosthetic valve=== | ||
*2 g IV q4h x6wk | *2 g IV q4h x6wk | ||
*Max: 12 g/day; Info: give | *Max: 12 g/day; Info: give with [[gentamicin]] 1-2mg/kg IV q8h x2wk and rifampin | ||
===Renal Dosing=== | ===Renal Dosing=== | ||
*Consider decrease dose if concomitant hepatic impairment | *Consider decrease dose if concomitant hepatic impairment | ||
Line 28: | Line 28: | ||
===Bacterial Infections=== | ===Bacterial Infections=== | ||
*0-4 wk old, <1200 g | *0-4 wk old, <1200 g | ||
*Dose: | *Dose: 50mg/kg/day IV divided q12h | ||
*<1 wk old, 1200-2000 g | *<1 wk old, 1200-2000 g | ||
*Dose: | *Dose: 50mg/kg/day IV divided q12h | ||
*<1 wk old, >2000 g | *<1 wk old, >2000 g | ||
*Dose: | *Dose: 75mg/kg/day IV divided q8h | ||
*1 wk old-1 mo, 1200-2000 g | *1 wk old-1 mo, 1200-2000 g | ||
*Dose: | *Dose: 75mg/kg/day IV divided q8h | ||
*1 wk old-1 mo, >2000 g | *1 wk old-1 mo, >2000 g | ||
*Dose: | *Dose: 100mg/kg/day IV divided q6h | ||
*1 mo-16 yo | *1 mo-16 yo | ||
*Dose: 50- | *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=== | ===[[Endocarditis]], Native valve=== | ||
*[1 mo-16 yo] | *[1 mo-16 yo] | ||
*Dose: | *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=== | ===[[Endocarditis]], Prosthetic valve=== | ||
*[1 mo-16 yo] | *[1 mo-16 yo] | ||
*Dose: | *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=== | ===Renal Dosing=== | ||
* No adjustment unless concomitant hepatic impairment | *No adjustment unless concomitant hepatic impairment | ||
*CrCl 10-29: 9- | *CrCl 10-29: 9-25mg/kg q6h if concomitant hepatic impairment; CrCl <10: 7.5-15mg/kg q6h if concomitant hepatic impairment | ||
===Hepatic Dosing=== | ===Hepatic Dosing=== | ||
*Consider decrease dose if concomitant renal impairment | *Consider decrease dose if concomitant renal impairment | ||
Line 57: | Line 57: | ||
==Contraindications== | ==Contraindications== | ||
*Hypersensitivity to drug/class. | *Hypersensitivity to drug/class. | ||
*Anaphylactic | *Anaphylactic reaction to beta-lactams | ||
*Caution if non-anaphylactic hypersensitivity to beta-lactams | *Caution if non-anaphylactic hypersensitivity to beta-lactams | ||
*Caution if hypersensitivity to multiple allergens | *Caution if hypersensitivity to multiple allergens | ||
*Caution if asthma or history of asthma. | *Caution if asthma or history of asthma. | ||
*Caution if recent | *Caution if recent antibiotic-associated colitis | ||
*Caution if seizure disorder | *Caution if seizure disorder | ||
*Caution if concomitant hepatic and renal impairment | *Caution if concomitant hepatic and renal impairment | ||
Line 92: | Line 92: | ||
*Mechanism of Action: bactericidal; inhibits cell wall mucopeptide synthesis | *Mechanism of Action: bactericidal; inhibits cell wall mucopeptide synthesis | ||
==[[Antibiotic Sensitivities]]<ref>Sanford Guide to Antimicrobial Therapy 2014</ref>== | |||
{| class="wikitable" | |||
| align="center" style="background:#f0f0f0;"|'''Group''' | |||
| align="center" style="background:#f0f0f0;"|'''Organism''' | |||
| align="center" style="background:#f0f0f0;"|'''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=== | |||
{{Template:Antibacterial Spectra Key}} | |||
==See Also== | ==See Also== | ||
*[[Antibiotics (Main)]] | *[[Antibiotics (Main)]] | ||
== | ==References== | ||
<references/> | <references/> | ||
[[Category: | [[Category:Pharmacology]] | ||
[[Category:ID]] |
Latest revision as of 23:46, 22 September 2019
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]
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
- ↑ Sanford Guide to Antimicrobial Therapy 2014