Yes

Antibiotic, Penicillin

Treatment of infections such as osteomyelitis, septicemia, endocarditis, and CNS infections caused by susceptible strains of staphylococci species

B

Hypersensitivity to nafcillin or any component or penicillins

Extravasation of I.V. infusions should be avoided; modification of dosage is necessary in patients with both severe renal and hepatic impairment; elimination rate will be slow in neonates; use with caution in patients with cephalosporin hypersensitivity

Percentage unknown: Fever, pain, rash, nausea, diarrhea, neutropenia, thrombophlebitis; oxacillin (less likely to cause phlebitis) is often preferred in pediatric patients, acute interstitial nephritis, hypersensitivity reactions

Symptoms of penicillin overdose include neuromuscular hypersensitivity (agitation, hallucinations, asterixis, encephalopathy, confusion, and seizures) and electrolyte imbalance with potassium or sodium salts, especially in renal failure

Hemodialysis may be helpful to aid in the removal of the drug from the blood, otherwise most treatment is supportive or symptom directed

Decreased effect: Efficacy of oral contraceptives may be reduced; warfarin/anticoagulants

Increased effect: Disulfiram, probenecid may increase penicillin levels

Refrigerate oral solution after reconstitution; discard after 7 days; reconstituted parenteral solution is stable for 3 days at room temperature and 7 days when refrigerated or 12 weeks when frozen; for I.V. infusion in NS or D₅W, solution is stable for 24 hours at room temperature and 96 hours when refrigerated

Interferes with bacterial cell wall synthesis during active multiplication, causing cell wall death and resultant bactericidal activity against susceptible bacteria

Absorption: Oral: Poor and erratic

Distribution: Widely distributed; CSF penetration is poor but enhanced by meningeal inflammation; crosses the placenta

Metabolism: Primarily in the liver; it undergoes enterohepatic circulation

Half-life:

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

Children 3 months to 14 years: 0.75-1.9 hours

Adults: 30 minutes to 1.5 hours, with normal renal and hepatic function

Time to peak serum concentration: Oral: Within 2 hours; I.M.: Within 30-60 minutes

Elimination: Primarily eliminated in bile, 10% to 30% in urine as unchanged drug; undergoes enterohepatic recycling

Neonates:

<2000 g, <7 days: 50 mg/kg/day divided every 12 hours

<2000 g, >7 days: 75 mg/kg/day divided every 8 hours

>2000 g, <7 days: 50 mg/kg/day divided every 8 hours

>2000 g, >7 days: 75 mg/kg/day divided every 6 hours

Children:

Oral: 25-50 mg/kg/day in 4 divided doses

I.M.: 25 mg/kg twice daily

I.V.:

Mild to moderate infections: 50-100 mg/kg/day in divided doses every 6 hours

Severe infections: 100-200 mg/kg/day in divided doses every 4-6 hours

Maximum dose: 12 g/day

Adults:

Oral: 250-500 mg (up to 1 g) every 4-6 hours

I.M.: 500 mg every 4-6 hours

I.V.: 500-2000 mg every 4-6 hours

Dosing adjustment in renal impairment: Not necessary

Dialysis: Not dialyzable (0% to 5%) via hemodialysis; supplemental dosage not necessary with hemo- or peritoneal dialysis or continuous arteriovenous or venovenous hemofiltration (CAVH/CAVHD)

Should be administered on an empty stomach, as there is decreased absorption with food

Periodic CBC, urinalysis, BUN, serum creatinine, AST and ALT; observe for signs and symptoms of anaphylaxis during first dose

Positive Coombs' test (direct), false-positive urinary and serum proteins; may inactivate aminoglycosides in vitro

Penicillins reported to cause apprehension, illusions, hallucinations, depersonalization, agitation, insomnia, and encephalopathy

May cause neutropenia; use caution with clozapine and carbamazepine

No information available to require special precautions

Prolonged use of penicillins may lead to the development of oral candidiasis

Oral: Take at regular intervals around-the-clock, preferably on and empty stomach with full glass of water. Take complete course of treatment as prescribed. You may experience nausea or vomiting; small frequent meals and good mouth care may help. If diabetic, drug may cause false tests with Clinitest® urine glucose monitoring; use of glucose oxidase methods (Clinistix®) or serum glucose monitoring is preferable. This drug may interfere with oral contraceptives; an alternate form of birth control should be used. Report persistent fever, sore throat, sores in mouth, diarrhea, unusual bleeding or bruising. Report difficulty breathing or skin rash. Notify prescriber if condition does not respond to treatment. Breast-feeding precautions: Consult prescriber if breast-feeding.

Extravasation: Use cold packs

Hyaluronidase (Wydase®): Add 1 mL NS to 150 unit vial to make 150 units/mL of concentration; mix 0.1 mL of above with 0.9 mL NS in 1 mL syringe to make final concentration = 15 units/mL

Capsule, as sodium: 250 mg

Powder for injection, as sodium: 500 mg, 1 g, 2 g, 4 g, 10 g

Solution, as sodium: 250 mg/5 mL (100 mL)

Tablet, as sodium: 500 mg

Banner W Jr, Gooch WM 3d, Burckart G, et al, "Pharmacokinetics of Nafcillin in Infants With Low Birth Weights," Antimicrob Agents Chemother, 1980, 17(4):691-4.

Donowitz GR and Mandell GL, "Beta-Lactam Antibiotics," N Engl J Med, 1988, 318(7):419-26 and 318(8):490-500.

Wright AJ, "The Penicillins," Mayo Clin Proc, 1999, 74(3):290-307.

Zenk KE, Dungy CL, and Greene CR, "Nafcillin Extravasation Injury: Use of Hyaluronidase as an Antidote," Am J Dis Child, 1981, 135(12):1113-4.