Nafcillin

Nafcillin
Clinical data
AHFS/Drugs.com Monograph
MedlinePlus a685019
Pregnancy
category
  • US: B (No risk in non-human studies)
    Routes of
    administration
    IM, IV
    ATC code
    Legal status
    Legal status
    • In general: ℞ (Prescription only)
    Pharmacokinetic data
    Protein binding 90%
    Metabolism <30% hepatic
    Elimination half-life 0.5 hours
    Excretion Biliary and renal
    Identifiers
    CAS Number
    PubChem CID
    DrugBank
    ChemSpider
    UNII
    ChEBI
    ChEMBL
    ECHA InfoCard 100.005.174
    Chemical and physical data
    Formula C21H22N2O5S
    Molar mass 414.476 g/mol
    3D model (JSmol)
      (verify)

    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:

    Interactions

    There is evidence that it induces cytochrome P-450 enzymes specifically CYP2C9. Several drugs with a narrow therapeutic 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

    1. 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. doi:10.1016/0003-4975(94)00992-9. PMID 7887701.
    2. 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.
    3. 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.
    4. 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. doi:10.1161/CIRCULATIONAHA.106.176857. PMID 16880336.
    5. JA Mohr. (1979). Nafcillin-associated hypokalemia. JAMA
    6. 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. doi:10.1046/j.1365-2125.2003.01789.x. PMC 1884262. PMID 12814453.
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