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Dear Readers! I started this blog when my daughter was in the NICU. She had ventriculitis. Her CSF report grew E.coli. But, she was injected Teicoplanin directly into her brain. The doctors made two errors here:

Teicoplanin is for gram-positive bacteria only. It does not treat E.coli.
Teicoplanin is not for intraventricular use. The manufacturer strongly discourage injecting Teicoplanin into the brain.

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Nafcillin - Uses, Dose, Side effects

Nafcillin is a narrow spectrum beta-lactamase-resistant penicillin used in the treatment of infections caused by gram-positive organisms resistant to other penicillins.

Nafcillin Uses:

Staphylococcal infections:
- for Treatment of infections caused by susceptible penicillinase-producing staphylococci
Off Label Use of Nafcillin in Adults:
- Catheter-related bloodstream infections;
- Skin and soft tissue necrotizing infection;
- Streptococcal skin infections;
- Surgical site infections
- Endocarditis caused by susceptible organisms.

Nafcillin Dose in Adults

Nafcillin Dose in the treatment of Catheter-related bloodstream infections (off-label):

IV: at 2 g every 4 hours.

Nafcillin Dose in the treatment of Endocarditis caused by Methicillin-susceptible Staphylococcus aureus (MSSA):

Native valve endocarditis:
- 12 g/day iV in 4 or 6 divided doses (ie, 2 g every 4 hours or 3 g every 6 hours) for 6 weeks.
- Note: Duration intended for complicated right-sided infective endocarditis (IE) or left-sided IE.
- For uncomplicated right-sided IE, 2 weeks of therapy may be enough.
Prosthetic valve endocarditis:
- 12 g/day IV in 6 divided doses (ie, 2 g every 4 hours) for ≥6 weeks (use with rifampin for entire course and gentamicin for first 2 weeks).

Nafcillin Dose in the treatment of bacterial Meningitis, bacterial caused by Methicillin-susceptible S. aureus:

IV:
- 2 g every 4 hours;
- consider the addition of rifampin if the organism is susceptible to it and prosthetic material is present.

Nafcillin Dose in the treatment of Osteomyelitis: Methicillin-susceptible S. aureus (MSSA) (off-label dose):

IV: at 1.5 to 2 g every 4 to 6 hours or via continuous infusion (IDSA [Berbari 2015])

Nafcillin Dose in the treatment of Prosthetic joint infections: Methicillin-susceptible S. aureus (MSSA):

5 to 2 g every 4 to 6 hours (IDSA [Osmon 2013])

Nafcillin Dose in the treatment of Skin and soft tissue infections:

Due to methicillin-susceptible Staphylococcus aureus (MSSA) (off-label dose):
- IV: 1 to 2 g every 4 hours for 7 to 14 days
Necrotizing infection due to MSSA (off-label use):
- IV:
  - at 1 to 2 g every 4 hours;
  - continue until further debridement is not necessary, the patient has clinically improved, and patient remains afebrile for 48 to 72 hours

Nafcillin Dose in the treatment of Streptococcal skin infections (off-label):

IV: at 1 to 2 g every 4 to 6 hours (IDSA [Stevens 2014])

Nafcillin Dose in the treatment of Surgical site infections (trunk or extremity away from axilla or perineum):

IV: 2 g every 6 hours (IDSA [Stevens 2014])

Nafcillin Dose in Childrens

Nafcillin General dosing in susceptible infections:

Mild to moderate infections: IM, IV:
- 100 to 150 mg/kg/day in divided doses every 6 hours;
- maximum daily dose: 4 g/day
Severe infections: IM, IV:
- at 150 to 200 mg/kg per day in divided doses every 4 to 6 hours;
- maximum daily dose: 12 g/day

Nafcillin Dose in the treatment of Endocarditis:

Children and Adolescents:
- Intravenous:
  - 200 mg/kg/day in divided doses every 4 to 6 hours;
  - maximum daily dose: 12 g/day;
  - treat for at least 4 weeks;
  - longer durations may be necessary;
  - It may be used in combination with gentamicin for some resistant organisms.

Nafcillin Dose in the treatment of Meningitis:

IV:
- at 200 mg/kg/day in divided doses every 6 hours;
- maximum daily dose: 12 g/day.

Nafcillin Dose in the treatment of Skin and soft tissue infections:

Methicillin-susceptible Staphylococcus aureus (MSSA):
- 100 to 150 mg/kg/day intravenous in divided doses every 6 hours;
- The maximum daily dose: 12 g/day
Necrotizing infection due to MSSA:
- 200 mg/kg/day intravenous in divided doses every 6 hours;
- maximum daily dose: 12 g/day;
- continue until further debridement is not necessary,
- patient has clinically improved,
- and patient stays afebrile for 48 to 72 hours

Nafcillin Dose in the treatment of Streptococcal skin infections:

IV: at 200 mg/kg/day in divided doses every 6 hours;
maximum daily dose: 12 g/day

Pregnancy Risk Factor B

Animal reproduction studies have not shown any adverse events.
Limited information is available on nafcillin usage during pregnancy.
Penicillins used by mothers during pregnancy have not been linked to an increase in birth defects.

Use of Nafcillin while breastfeeding

Breast milk is free from penicillins.
The drug manufacturer suggests that nursing mothers exercise caution when using nafcillin.
Modification of the bowel flora could also be a non-dose-related effect.

Nafcillin Dose in Kidney Disease:

No dosage adjustment necessary;
use with caution in patients with concomitant hepatic impairment.
Poorly dialyzed.
No supplemental dose or dosage adjustment necessary, including patients on intermittent hemodialysis, peritoneal dialysis, or continuous renal replacement therapy (eg, CVVHD).

Nafcillin Dose in Liver disease:

There are no dosage adjustments provided in the drug manufacturer's labeling.
Nafcillin primarily undergoes hepatic metabolism;
dosage adjustment may be necessary, particularly in the setting of concomitant renal impairment.

Side effects of Nafcillin:

Cardiovascular:
- Local Thrombophlebitis
Central Nervous System:
- Neurotoxicity (High Doses)
Gastrointestinal:
- Cholestasis
- Clostridioides (Formerly Clostridium) Difficile-Associated Diarrhea
Hematologic & Oncologic:
- Agranulocytosis
- Bone Marrow Depression
- Neutropenia
Hepatic:
- Increased Serum Transaminases
Hypersensitivity:
- Anaphylaxis
Local:
- Inflammation At Injection Site
- Injection Site Phlebitis
- Local Skin Exfoliation (At Injection Site)
- Pain At Injection Site
- Swelling At Injection Site
Renal:
- Interstitial Nephritis
- Renal Tubular Disease

Contraindications to Nafcillin:

Hypersensitivity/ hyperresponsiveness of nafcillin or other penicillins or any component in the formulation
Limited documentation exists on cross-reactivity between beta-lactams (eg penicillins or cephalosporins), which can cause allergenic reactions.
Cross-sensitivity is possible due to similarities in chemical structure or mechanism of action.

Warnings and precautions

Anaphylactic and hypersensitivity reactions
- Patients on penicillin therapy have had severe, sometimes fatal, hypersensitivity/ hyperresponsiveness reactions (anaphylactic) observed.
- This is especially true if they have a history beta-lactam hypersensitivity and/or sensitivity to multiple allergens.
- Patients with severe allergies or asthma should be cautious.
- If an allergic reaction occurs, discontinue the treatment and initiate appropriate/appropriate therapy.
Extravasation:
- Avoid IV Infusions Extravasation
- Before and during infusion, ensure that the catheter or needle is properly positioned.
Hepatic effects
- High doses of alcohol can lead to liver transaminases elevation and/or cholestasis.
- Patients with a worsening of hepatic function should be evaluated.
Neurotoxic effects
- Neurotoxicity has been linked to large intraventricular or IV doses.
- Patients with renal or hepatic dysfunction should exercise caution.
Superinfection
- Long-term use may result in fungal or bacterial superinfection, including pseudomembranous colitis and C.difficile-associated diarrhoea (CDAD); CDAD was noted after more than two months of post-antibiotic treatment.
Heart failure:
- It may contain significant amounts of sodium.
- Use caution in the event of heart failure
Hepatic and renal impairment
- Patients with concomitant renal and hepatic impairments should be used with caution.

Nafcillin: Drug Interaction

Risk Factor C (Monitor therapy)
Acemetacin	Could raise the serum level of penicillins.
BCG Vaccine (Immunization)	Antibiotics may reduce the BCG vaccine's therapeutic effect (Immunization).
Benzhydrocodone	CYP3A4 Inducers (Moderate) may lower the level of benzhydrocodone in the blood. More specifically, hydrocodone serum concentrations might be decreased.
CloZAPine	CloZAPine's serum levels may be lowered by moderate CYP3A4 inducers.
Codeine	The active metabolite(s) of codeine's serum concentrations may be lowered by CYP3A4 Inducers (Moderate).
CycloSPORINE (Systemic)	Nafcillin may speed up CycloSPORINE metabolism (Systemic).
CYP3A4 Substrates (High risk with Inducers)	The serum concentration of CYP3A4 Substrates may drop when taking CYP3A4 Inducers (Moderate) (High risk with Inducers). Apixaban and Rivaroxaban are exceptions.
Doravirine	The serum concentration of doravirine may drop in response to CYP3A4 Inducers (Moderate).
Estriol (Systemic)	Estriol serum levels may be decreased by moderately potent CYP3A4 inducers (Systemic).
Estriol (Topical)	Estriol serum levels may be decreased by moderately potent CYP3A4 inducers (Topical).
FentaNYL	The serum concentration of FentaNYL may drop in response to CYP3A4 Inducers (Moderate).
Glecaprevir and Pibrentasvir	Glecaprevir and Pibrentasvir's serum concentrations may be affected by CYP3A4 Inducers (Moderate).
HYDROcodone	The serum levels of HYDROcodone may drop in response to CYP3A4 Inducers (Moderate).
Ibrutinib	Ibrutinib's serum levels may be decreased by CYP3A4 Inducers (Moderate).
Ifosfamide	The active metabolite(s) of ifosfamide may be present in lower serum quantities when CYP3A4 Inducers (Moderate) are present. The active metabolite(s) of ifosfamide may be present in higher serum concentrations when CYP3A4 Inducers (Moderate) are used.
Lactobacillus and Estriol	The therapeutic effects of Lactobacillus and Estriol may be reduced by antibiotics.
Methotrexate	Penicillins may raise the level of methotrexate in the serum.
Mirodenafil	The serum concentration of Mirodenafil may be decreased by CYP3A4 Inducers (Moderate).
Mycophenolate	The serum levels of the active metabolite(s) of mycophenolate may drop when penicillins are used. Enterohepatic recirculation appears to be hindered, which has this impact.
Naldemedine	The serum concentration of naldemedine may drop in response to CYP3A4 Inducers (Moderate).
NiMODipine	NiMODipine's serum levels may be decreased by CYP3A4 Inducers (Moderate).
Pexidartinib	Pexidartinib's serum levels may be decreased by CYP3A4 Inducers (Moderate).
Pitolisant	Pitolisant's serum levels may drop when taken with CYP3A4 Inducers (Moderate).
Probenecid	May increase the serum concentration of Penicillins.
Rolapitant	CYP3A4 Inducers (Moderate) may decrease the serum concentration of Rolapitant.
Upadacitinib	CYP3A4 Inducers (Moderate) may decrease the serum concentration of Upadacitinib.
Zolpidem	CYP3A4 Inducers (Moderate) may decrease the serum concentration of Zolpidem.
Risk Factor D (Consider therapy modification)
Brigatinib	The serum concentration of Brigatinib may fall in response to CYP3A4 Inducers (Moderate). Management: Whenever possible, avoid taking brigatinib at the same time as mild CYP3A4 inducers. After seven days of treatment with the current brigatinib dose, increase the daily dose in increments of 30 mg,
Clarithromycin	The active metabolite(s) of clarithromycin may be present in higher serum quantities when CYP3A4 Inducers (Moderate) are present. It is possible for CYP3A4 Inducers (Moderate) to lower the level of clarithromycin in the blood. If a patient is receiving a CYP3A inducer, other antimicrobial therapy should be considered. Drugs that speed up the conversion of 14-hydroxyclarithromycin from clarithromycin may change the clinical action of clarithromycin and reduce its effectiveness.
Daclatasvir	Daclatasvir's serum levels may be lowered by moderate CYP3A4 inducers. Treatment: If daclatasvir is used with a moderate CYP3A4 inducer, increase the dose to 90 mg once daily.
Erdafitinib	Erdafitinib's serum levels may be decreased by CYP3A4 Inducers (Moderate). Management: Erdafitinib dosage adjustments may be necessary. For information, see the entire monograph.
Estrogen Derivatives (Contraceptive)	Estrogen derivatives' metabolism may be accelerated by nafcillin (Contraceptive). Treatment: It is advised to use an alternative, nonhormonal method of contraception while using nafcillin.
GuanFACINE	GuanFACINE serum levels may be decreased by CYP3A4 Inducers (Moderate). Treatment: When starting guanfacine in a patient receiving a moderate CYP3A4 inducer, increase the guanfacine dose by up to a factor of two. If a patient is currently receiving guanfacine and a moderate CYP3A4 inducer is started, gradually increase the guanfacine dose over the course of 1 to 2 weeks.
Lefamulin	Lefamulin's serum levels may be decreased by CYP3A4 Inducers (Moderate). Management: Unless the advantages outweigh the hazards, avoid using lefamulin concurrently with mild CYP3A4 inducers.
Lefamulin (Intravenous)	Lefamulin serum levels may be decreased by moderate CYP3A4 inducers (Intravenous). Management: Lefamulin (intravenous) should not be used concurrently with moderate CYP3A4 inducers unless the advantages outweigh the dangers.
Lorlatinib	The hepatotoxic impact of lorlatinib may be enhanced by CYP3A4 Inducers (Moderate). Lorlatinib's serum levels may be decreased by CYP3A4 Inducers (Moderate). Avoid using lorlatinib in combination with mild CYP3A4 inducers. If such a mixture must be used, AST, ALT, and bilirubin levels should be checked within 48 hours after beginning the mixture and at least three times during the first week of use.
Lurasidone	Lurasidone's serum levels may be reduced by moderate CYP3A4 inducers. Management: If provided with moderate CYP3A4 inducers for seven or more days, watch for any diminished effects of the lurasidone and consider raising the dose.
Meperidine	Meperidine's serum levels may drop if you take CYP3A4 Inducers (Moderate). When using mild CYP3A4 inducers concurrently, the dose of meperidine may need to be increased. Keep an eye out for the effects of opioid withdrawal.
NIFEdipine	Nafcillin may lower NIFEdipine's serum levels.
Palbociclib	Palbociclib's serum levels may be decreased by moderate CYP3A4 inducers. Management: The Canadian label advises against using mild CYP3A4 inducers, however the US label makes no particular advice on their use.
Perampanel	The serum concentration of Perampanel may be decreased by CYP3A4 Inducers (Moderate). When using perampanel alongside strong and moderate CYP3A4 inducers, the beginning dose should be increased to 4 mg/day.
Sodium Picosulfate	Antibiotics may reduce Sodium Picosulfate's therapeutic impact. Management: If a patient previously used or is currently using an antibiotic, think about utilising an alternative product for bowel cleansing prior to a colonoscopy.
Tetracyclines	May reduce penicillins' therapeutic efficacy.
Typhoid Vaccine	The Typhoid Vaccine's therapeutic benefits may be reduced by antibiotics. The only strain impacted is the live attenuated Ty21a strain. Treatment: Patients receiving systemic antibacterial drugs should refrain from receiving the live attenuated typhoid vaccination (Ty21a). It is recommended to wait at least 3 days following the last dose of antibacterial medication before administering this vaccine.
Vitamin K Antagonists (eg, warfarin)	The anticoagulant impact of Vitamin K antagonists may be lessened by nafcillin. Management: Take into account using a different antibiotic. When starting or increasing the dosage of nafcillin, keep an eye out for increased or decreased therapeutic effects and the need to change the dose of oral anticoagulants.
Risk Factor X (Avoid combination)
Abemaciclib	Abemaciclib's serum levels may be reduced by moderate CYP3A4 inducers.
Antihepaciviral Combination Products	Antihepaciviral Combination Products' serum concentration may be decreased by CYP3A4 Inducers (Moderate).
Asunaprevir	Asunaprevir's serum levels may be decreased by CYP3A4 Inducers (Moderate).
Axitinib	Axitinib's serum levels may be decreased by CYP3A4 Inducers (Moderate).
BCG (Intravesical)	Antibiotics may lessen BCG's therapeutic effects (Intravesical).
Bedaquiline	Bedaquiline's serum levels may be lowered by moderately potent CYP3A4 inducers.
Bosutinib	Bosutinib's serum levels may be decreased by CYP3A4 Inducers (Moderate).
Cholera Vaccine	The therapeutic benefit of the cholera vaccine may be reduced by antibiotic use. Management: Cholera vaccine should not be administered to individuals taking systemic antibiotics or within 14 days after taking oral or parenteral antibiotics.
Cobimetinib	CYP3A4 Inducers (Moderate) may decrease the serum concentration of Cobimetinib.
Dasabuvir	Dasabuvir's serum levels may be decreased by moderate CYP3A4 inducers.
Deflazacort	CYP3A4 Inducers (Moderate) may decrease serum concentrations of the active metabolite(s) of Deflazacort.
Elbasvir	CYP3A4 Inducers (Moderate) may decrease the serum concentration of Elbasvir.
Encorafenib	CYP3A4 Inducers (Moderate) may decrease the serum concentration of Encorafenib.
Entrectinib	CYP3A4 Inducers (Moderate) may decrease the serum concentration of Entrectinib.
Fedratinib	CYP3A4 Inducers (Moderate) may decrease the serum concentration of Fedratinib.
Flibanserin	CYP3A4 Inducers (Moderate) may decrease the serum concentration of Flibanserin.
Grazoprevir	CYP3A4 Inducers (Moderate) may decrease the serum concentration of Grazoprevir.
Neratinib	CYP3A4 Inducers (Moderate) may decrease the serum concentration of Neratinib.
Nisoldipine	The serum concentration of nisoldipine may fall in response to CYP3A4 Inducers (Moderate).
Olaparib	Olaparib's serum levels may be decreased by CYP3A4 Inducers (Moderate).
Pimavanserin	Pimavanserin's serum levels may be decreased by moderate CYP3A4 inducers.
Pretomanid	Pretomanid's serum levels may be decreased by CYP3A4 Inducers (Moderate).
Ranolazine	Ranolazine's serum levels may be reduced by moderate CYP3A4 inducers.
Simeprevir	Simeprevir's serum levels may be decreased by CYP3A4 Inducers (Moderate).
Sonidegib	Sonidegib's serum levels may be decreased by CYP3A4 Inducers (Moderate).
Velpatasvir	CYP3A4 Inducers (Moderate) may decrease the serum concentration of Velpatasvir.
Venetoclax	Venetoclax serum levels may be decreased by CYP3A4 Inducers (Moderate).

Monitoring parameters:

Baseline and periodic CBC with differential,
urinalysis,
BUN, serum creatinine;
should do baseline and periodic serum bilirubin, AST, ALT, alkaline phosphatase and gamma glutamyl transferase (especially when using high doses);
observe for signs and symptoms of anaphylaxis during administration of first dose.
Monitor infusion site.

How to administer Nafcillin?

IM:
- Administer as a deep intragluteal injection;
- rotate injection sites.
IV:
- Infuse over 30 to 60 minutes.
- Vesicant
- Avoid extravasation.

Extravasation management:

Extravasation should be stopped immediately, and the needle or cannula should be left in place.
Aspirate extravasated solution slowly without flushing the line;
initiate hyaluronidase antidote;
remove needle/cannula in case of not using IV hyaluronidase antidote),
apply dry cold compressions.
elevate extremity.

Hyaluronidase:

Intradermal or SubQ:
- Use a 25-gauge needle to provide 5 sequential 0.2 to 0.3 mL injections totaling 1 to 1.7 mL (15 units/mL) clockwise into the extravasation area at the leading edge.

Mechanism of action of Nafcillin:

Interferes during active multiplication with the bacterial cell wall synthesis, leading to cell wall destruction and bactericidal activity.
It can be inactivated by staphylococcal penicillinase.

Distribution:

Widely distributed; CSF penetration is poor but enhanced by meningeal inflammation

Protein binding:

~90%; primarily to albumin

Metabolism:

Primarily hepatic; undergoes enterohepatic recirculation

Half-life elimination:

Neonates <3 weeks: 2.2 to 5.5 hours; 4 to 9 weeks: 1.2 to 2.3 hours
Infants and Children 1 month to 14 years: 0.75 to 1.9 hours
Adults: Normal renal/hepatic function: 33 to 61 minutes

Time to peak serum concentrations:

IM: 30 to 60 minutes

Excretion:

Primarily feces; urine (~30% as unchanged drug)

Nafcillin Brand Names (International):

Nafcil Nallpen

Nafcillin Brand Names in Pakistan:

No Brands Available in Pakistan.

Disclaimer Notice:

Emedz.net is not an online pharmacy:

We are not affiliated with any pharmaceutical companies:

Nafcillin - Uses, Dose, Side effects

Nafcillin Uses:

Staphylococcal infections:

Off Label Use of Nafcillin in Adults:

Nafcillin Dose in Adults

Nafcillin Dose in the treatment of Catheter-related bloodstream infections (off-label):

Nafcillin Dose in the treatment of Endocarditis caused by Methicillin-susceptible Staphylococcus aureus (MSSA):

Nafcillin Dose in the treatment of bacterial Meningitis, bacterial caused by Methicillin-susceptible S. aureus:

Nafcillin Dose in the treatment of Osteomyelitis: Methicillin-susceptible S. aureus (MSSA) (off-label dose):

Nafcillin Dose in the treatment of Prosthetic joint infections: Methicillin-susceptible S. aureus (MSSA):

Nafcillin Dose in the treatment of Skin and soft tissue infections:

Due to methicillin-susceptible Staphylococcus aureus (MSSA) (off-label dose):

Necrotizing infection due to MSSA (off-label use):

Nafcillin Dose in the treatment of Streptococcal skin infections (off-label):

Nafcillin Dose in the treatment of Surgical site infections (trunk or extremity away from axilla or perineum):

Nafcillin Dose in Childrens

Nafcillin General dosing in susceptible infections:

Mild to moderate infections: IM, IV:

Severe infections: IM, IV:

Nafcillin Dose in the treatment of Endocarditis:

Children and Adolescents:

Nafcillin Dose in the treatment of Meningitis:

Nafcillin Dose in the treatment of Skin and soft tissue infections:

Nafcillin Dose in the treatment of Streptococcal skin infections:

Pregnancy Risk Factor B

Use of Nafcillin while breastfeeding

Nafcillin Dose in Kidney Disease:

Nafcillin Dose in Liver disease:

Side effects of Nafcillin:

Cardiovascular:

Central Nervous System:

Gastrointestinal:

Hematologic & Oncologic:

Hepatic:

Hypersensitivity:

Local:

Renal:

Contraindications to Nafcillin:

Warnings and precautions

Anaphylactic and hypersensitivity reactions

Extravasation:

Hepatic effects

Neurotoxic effects

Superinfection

Heart failure:

Hepatic and renal impairment

Monitoring parameters:

How to administer Nafcillin?

IM:

IV:

Mechanism of action of Nafcillin:

Nafcillin Brand Names (International):

Nafcillin Brand Names in Pakistan:

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