Nafcillin
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| Clinical data | |
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| AHFS/Drugs.com | Monograph |
| MedlinePlus | a685019 |
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| Routes of administration | IM, IV |
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| Pharmacokinetic data | |
| Protein binding | 90% |
| Metabolism | <30% hepatic |
| Biological half-life | 0.5 hours |
| Excretion | Biliary and renal |
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| ChEMBL | |
| ECHA InfoCard | 100.005.174 |
| Chemical and physical data | |
| Formula | C21H22N2O5S |
| Molar mass | 414.476 g/mol |
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Nafcillin sodium is a narrow-spectrum[1] beta-lactam antibiotic[2] of the penicillin class. As a beta-lactamase-resistant penicillin, it is used to treat infections caused by Gram-positive bacteria, in particular, species of staphylococci that are resistant to other penicillins.
Nafcillin is considered therapeutically equivalent to oxacillin, although its safety profile is somewhat different.[3]
Indications
Nafcillin is indicated in the treatment of staphylococcal infections, except those caused by MRSA.[3]
U.S. clinical practice guidelines recommend either nafcillin or oxacillin as the first-line treatment of choice for staphylococcal endocarditis in patients without artificial heart valves.[4]
Side-effects
As with all penicillins, serious life-threatening allergic reactions can occur.
Milder side-effects include:
- Hypokalemia[5]
- Nausea and vomiting
- Diarrhea, often due to suppression of normal gastrointestinal bacteria, which, on occasion, leads to a more serious super-infection with an organism like Clostridium difficile
- Abdominal pain
- Yeast infections (thrush) affecting the mouth and tongue or vagina
- Agranulocytosis, neutropenia
Interactions
There is evidence that it induces cytochrome P-450 enzymes specifically CYP2C9. Several drugs with a narrow theraputic window, such as warfarin and nifedipine, are metabolized by CYP2C9.[6]
Nafcillin contains salts added as stability media. These added salts could cause edema or fluid accumulation. It would be prudent to avoid this medication if there were a concern for a congestive heart failure or kidney disease.
References
- ↑ Palmer DL, Pett SB, Akl BF (March 1995). "Bacterial wound colonization after broad-spectrum versus narrow-spectrum antibiotics". Ann. Thorac. Surg. 59 (3): 626–31. PMID 7887701. doi:10.1016/0003-4975(94)00992-9.
- ↑ Tan AK, Fink AL (January 1992). "Identification of the site of covalent attachment of nafcillin, a reversible suicide inhibitor of beta-lactamase". Biochem. J. 281 (1): 191–6. PMC 1130660
. PMID 1731755. - 1 2 Pham P, Bartlett JG (January 2, 2009). "Nafcillin". Point-of-Care Information Technology ABX Guide. Johns Hopkins University. Retrieved on July 10, 2009. Freely available with registration.
- ↑ Bonow RO, Carabello BA, Kanu C, et al. (August 2006). "ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): developed in collaboration with the Society of Cardiovascular Anesthesiologists: endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons". Circulation. 114 (5): e84–231. PMID 16880336. doi:10.1161/CIRCULATIONAHA.106.176857.
- ↑ JA Mohr. (1979). Nafcillin-associated hypokalemia. JAMA
- ↑ Lang CC, Jamal SK, Mohamed Z, Mustafa MR, Mustafa AM, Lee TC (June 2003). "Evidence of an interaction between nifedipine and nafcillin in humans". Br J Clin Pharmacol. 55 (6): 588–90. PMC 1884262 . PMID 12814453. doi:10.1046/j.1365-2125.2003.01789.x.