Nafcillin Explained

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 one retrospective study found greater rates of hypokalemia and acute kidney injury in patients taking nafcillin compared to patients taking oxacillin.[3]

Indications

Nafcillin is indicated in the treatment of staphylococcal infections, except those caused by MRSA.[4]

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.[5]

Side-effects

As with all penicillins, serious life-threatening allergic reactions can occur.

Milder side-effects include:

Interactions

There is evidence that nafcillin induces cytochrome P-450 enzymes, specifically CYP2C9. Several drugs with a narrow therapeutic window, such as warfarin and nifedipine, are metabolized by CYP2C9.[7]

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.

Notes and References

  1. Palmer DL, Pett SB, Akl BF . Bacterial wound colonization after broad-spectrum versus narrow-spectrum antibiotics . The Annals of Thoracic Surgery . 59 . 3 . 626–631 . March 1995 . 7887701 . 10.1016/0003-4975(94)00992-9 . free .
  2. Tan AK, Fink AL . Identification of the site of covalent attachment of nafcillin, a reversible suicide inhibitor of beta-lactamase . The Biochemical Journal . 281 . Pt 1 . 191–196 . January 1992 . 1731755 . 1130660 . 10.1042/bj2810191 .
  3. Viehman JA, Oleksiuk LM, Sheridan KR, Byers KE, He P, Falcione BA, Shields RK . Adverse Events Lead to Drug Discontinuation More Commonly among Patients Who Receive Nafcillin than among Those Who Receive Oxacillin . Antimicrobial Agents and Chemotherapy . 60 . 5 . 3090–3095 . May 2016 . 26976858 . 4862451 . 10.1128/AAC.03122-15 .
  4. Web site: Nafcillin . Pham P, Bartlett JG . January 2, 2009 . Point-of-Care Information Technology ABX Guide . Johns Hopkins University. Retrieved on July 10, 2009. Freely available with registration.
  5. Bonow RO, Carabello BA, Kanu C, de Leon AC, Faxon DP, Freed MD, Gaasch WH, Lytle BW, Nishimura RA, O'Gara PT, O'Rourke RA, Otto CM, Shah PM, Shanewise JS, Smith SC, Jacobs AK, Adams CD, Anderson JL, Antman EM, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Hunt SA, Lytle BW, Nishimura R, Page RL, Riegel B . 6 . 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 . August 2006 . 16880336 . 10.1161/CIRCULATIONAHA.106.176857 . free .
  6. Mohr JA, Clark RM, Waack TC, Whang R . Nafcillin-associated hypokalemia . JAMA . 242 . 6 . 544 . August 1979 . 448989 . 10.1001/jama.1979.03300060046028.
  7. Lang CC, Jamal SK, Mohamed Z, Mustafa MR, Mustafa AM, Lee TC . Evidence of an interaction between nifedipine and nafcillin in humans . British Journal of Clinical Pharmacology . 55 . 6 . 588–590 . June 2003 . 12814453 . 1884262 . 10.1046/j.1365-2125.2003.01789.x .

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