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Nafcillin

[Nafcillin photo]

KEY POINTS

  • Nafcillin is an anti-staphylococcal penicillin aka penicillinase-resistant penicillin
    • This class is sometimes referred to as the “CONDOM” drugs
      • CONDOM = cloxacillin, oxacillin, nafcillin, dicloxacillin, oxacillin (again), methicillin
      • Not common to use this term in practice, but helps for studying
    • Works by interfering with cell wall synthesis in susceptible bacteria via penicillin binding proteins (PBPs)
  • Nafcillin and oxacillin are the injectable drugs in this class
    • They are very similar and typically an institution will carry whichever is cheaper
      • Although relatively old and available in generic formulations, these drugs are commonly high-cost
  • Like cefazolin (Ancef), nafcillin is a go-to drug for treating methicillin-sensitive Staphylococcus aureus (MSSA) infections
    • Infrequently used for non-MSSA infections
  • Common dose in adults is 2gm IV every 4-6 hours
    • May be given as a continuous infusion (e.g., 10g or 12g administered over 20 or 24 hours)
    • No need to adjust doses for renal insufficiency
  • Beware AST/ALT elevations,  interstitial nephritis (reason methicillin was removed from the market), sodium load (particularly in elderly or patients with congestive heart failure) and hypersensitivity reaction
    • Nafcillin is said to have more thrombophlebitis than oxacillin, however the clinical relevance of this is unclear

RESOURCES

  • Nafcillin Package Insert
  • Li J, et al. β-Lactam Therapy for Methicillin-Susceptible Staphylococcus Aureus Bacteremia: A Comparative Review of Cefazolin Versus Antistaphylococcal Penicillins. Pharmacotherapy (2017)
  • Surgical Prophylaxis Guidelines – ASHP
  • IDSA Practice Guidelines

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