Adult Dosing
Infections caused by penicillinase-producing staphylococci
- 0.5-2 g IV q4-6 hrs; administer slowly over at least 30-60 minutes
Orbital cellulitis [Non-FDA Approved]
Pediatric Dosing
- Safety and effectiveness in pediatric patients have not been established
Cellulitis [Non-FDA Approved]
Orbital cellulitis [Non-FDA Approved]
- 100-200 mg/kg/day IM/IV divided q4-6h
Osteomyelitis [Non-FDA Approved]
- Wt <2 kg; Age 0-7 Days: 25 mg/kg/dose IV q12h
- Wt <2 kg; Age 8-28 Days: 25 mg/kg/dose IV q8h
- Wt >2 kg; Age 0-7 Days: 25 mg/kg/dose IV q8h
- Wt >2 kg; Age 8-28 Days: 25 mg/kg/dose IV q6h
- Infants Age >28 Days: 25 mg/kg/dose IV q6h
- Children:25 mg/kg/dose IV q6 h (max: 8-12 gm/day)
[Outline]
- Serious hypersensitivity (anaphylactic) reactions have been reported in patients on nafcillin therapy, and are more likely to occur in individuals with a history of penicillin hypersensitivity and/or a history of sensitivity to multiple allergens
- Before starting nafcillin, carefully inquire about previous hypersensitivity reaction to penicillin, cephalosporins, or other allergens
- If allergic reaction occurs, discontinue the drug and provide immediate emergency treatment with epinephrine, oxygen, intravenous steroids, and provide airway management including intubation
- Clostridium difficile associated diarrhea (CDAD) ranging from mild diarrhea to fatal colitis occurs with nafcillin therapy, as antibacterial agents alter the normal flora of the colon leading to overgrowth of C. difficile
- C. difficile produces toxins A and B which contribute to CDAD. Hypertoxin producing strains cause increased morbidity and mortality since these infections can be refractory to antibiotic therapy and may require colectomy. Careful medical examination is necessary since CDAD may occur >2 months after administration of drug
- If CDAD is suspected/confirmed discontinue the treatment, provide fluid, electrolyte, and protein supplementation along with antibiotics for C. difficile, and surgical evaluation as needed
- Bleeding manifestations have occurred in some patients. If bleeding manifestations occur, the drug should be discontinued and appropriate therapy instituted
- Superinfections due to emergence of resistant organisms can occur particularly during prolonged treatment
- As nafcillin contains monosodium salt, use cautiously in patients requiring restricted salt intake and evaluate electrolyte levels periodically in patients with low potassium reserves
- Leukopenia and neutropenia may occur during prolonged therapy
- Prescribing antibiotics in the absence of proven or strongly suspected bacterial infection increases the risk of development of drug-resistant bacteria
Cautions: Use cautiously in
- Renal Impairment
- Hepatic impairment
- Penicillin-sensitive patients
- Hypokalemia
- Salt restriction
Pregnancy Category:B
Breastfeeding: Safety unknown. Manufacturer advises caution.
US Trade Name(s)
US Availability
nafcillin (generic)
- PWDR for INJ: 1 mg/vial
- PWDR for INJ: 2 mg/vial
- SOLN for INJ: 10 gm/vial
Nallpen In Plastic Container
- SOLN for INJ: 1 g/50 mL (50, 100 mL containers)
Canadian Trade Name(s)
Canadian Availability
UK Trade Name(s)
UK Availability
Australian Trade Name(s)
Australian Availability
[Outline]
