Antimicrobials
Nafcillin

Nafcillin

Spectrum of Activity

Dosing

General Information

Administration

  • Infuse over 30-60 minutes
  • Vesicant, so ensure proper needle or catheter placement prior to initiating infusion

If extravasation occurs:

  • Stop infusion and disconnect, leaving needle or cannula in place
  • Gently aspirate extravasated solution (Do Not Flush Line)
  • Initiate hyaluronidase antidote then remove needle/cannula
  • Apply dry cold compresses and elevate extremity

For continuous infusion:

  • 12 g in 300 mL of NS, administered over 24 hours

Preparation

  • Reconstitute with NS or SWFI (amount depends on manufacturer)
  • Further dilute in appropriate fluid, not to exceed final concentration 40mg/mL Fluid-restricted patients may require higher concentrations:
  • D5W 71mg/mL
  • NS 62mg/mL
  • SWFI 125mg/mL

Diluent

  • SWFI, NS, D5W, LR, or other compatible diluent

Susceptible Staphylococcal sp. (MSSA) infections

  • Bacteremia
  • Osteomyelitis
  • SSTI
  • Endocarditis

Tier 1 Protected Antimicrobial

  • Narrow spectrum, possible transition for discharge, IV to PO
  • Strategy: Total EBM duration set (inpatient and outpatient)

Monitor infusion site for extravasation

  • Baseline and periodic CBC with differential
  • Urinalysis
  • BUN and SCr
  • Baseline and periodic serum bilirubin and hepatic enzymes
  • Local thrombophlebitis
  • Neuotoxicity at high doses
  • Cholestasis
  • Myelosuppression
  • Agranulocytosis
  • Neutropenia
  • Interstitial nephritis and renal tubular disease

A lot of drug interactions, including contraindications

  • Anti-viral drugs
  • CYP 3A4 inducers

Contact pharmacy with drug-interaction questions

Mechanism of action: Penicillin inhibiting cell wall synthesis

Average half-life: 0.5-1 hour

  • Neonates < 3 weeks: 2.2-5.5 hours
  • Neonates 4-9 weeks: 1.2-2.3 hours

CSF penetration: Poor, enhanced by inflamed meninges

Otherwise wide distribution and penetration