Nafcillin
M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson in Kucers’ The Use of Antibiotics, 2017
Nafcillin can be used to treat severe hospital-acquired infections caused by these organisms, such as prosthetic valve endocarditis and prosthetic joint infections, provided the strain is susceptible to methicillin. Breakpoints for S. lugdunensis are higher compared to other coagulase-negative staphylococci, similar to those for S. aureus. (see Chapter 7, Isoxazolyl penicillins: oxacillin, cloxacillin, dicloxacillin and flucloxacillin, section 2a, Routine susceptibility, for more information about susceptibility). The addition of either gentamicin or rifampicin or both to the nafcillin regimen may improve the results of treatment (Sande and Scheld, 1980). In the USA, nafcillin or oxacillin in combination with rifampicin is the preferred therapy for prosthetic joint infections with retained hardware or one-stage exchange (Osmon et al., 2013) and in combination with rifampicin and gentamicin for treatment of prosthetic valve or prosthetic material endocarditis (Baddour et al., 2015).
Penicillins
Thomas T. Yoshikawa, Shobita Rajagopalan in Antibiotic Therapy for Geriatric Patients, 2005
This group includes nafcillin and the isoxazyl penicillins (oxacillin, cloxacillin, and dicloxacillin). Emergence of resistant S. aureus ((-lactamase producing) led to development of this group of penicillins. Methicillin was the first member, which is infrequently prescribed now because of high rates of interstitial nephritis. Nafcillin is mainly used parenterally for staphylococcal infections. However, with the increasing prevalence of MRSA (which are resistant to all penicillins, and most cepahlos-porins, and carbapenems), the role of these penicillins in treating staphylococcal infections is decreasing. Nafcillin excretion is primarily via the liver; therefore, the dose may not require adjustment in patients with mild to moderate renal dysfunction. Serum levels and half-life can be increased by coadministration of probenicid. Nafcillin is highly protein bound (90%).
Drugs causing cutaneous necrosis
Biju Vasudevan, Rajesh Verma in Dermatological Emergencies, 2019
Broad-spectrum antibiotics are preferred as most of the infections are polymicrobial. Options include combinations such as ampicillin, gentamicin, and clindamycin or metronidazole. Ampicillin-sulbactam, ticarcillin-clavulanate potassium, and piperacillin-tazobactam also provide adequate anaerobic and aerobic coverage. Piperacillin-tazobactam or ticarcillin-clavulanate potassium therapy has the advantage of providing gram-negative and pseudomonas coverage. Nafcillin plus agents with anaerobic and gram-negative coverage has also been used in the treatment of such infections [83–86]. Skin necrosis may be due to necrotizing infections secondary to neutropenia caused by various drugs.
Iclaprim: a differentiated option for the treatment of skin and skin structure infections
Published in Expert Review of Anti-infective Therapy, 2018
Stephanie Noviello, David B. Huang, G. Ralph Corey
The effect of iclaprim and trimethoprim on the expression and production of these toxins in vitro has been evaluated for MRSA and vancomycin intermediate S. aureus (VISA) [34]. MRSA were cultured using high initial inoculum conditions (>107 CFU/mL) to ensure detectable levels of toxin were achieved. Northern blotting was performed to analyze the expression of hla, lukf, and tst. For MRSA isolates, iclaprim and trimethoprim delayed the onset of mRNA production and shifted its peak production to later time points. Trimethoprim significantly increased PVL production compared to iclaprim-sub MIC treated isolates (Table 4). Iclaprim and trimethoprim suppressed, but did not eliminate, AH production and delayed, but did not reduce, maximal TSST-1 production. However, nafcillin increased production of the exotoxins, AH, PVL, and TSST-1. Higher concentrations of iclaprim and trimethoprim markedly suppressed mRNA synthesis and toxin production.
Choosing the appropriate pharmacotherapy for multidrug-resistant Gram positive infections
Published in Expert Opinion on Pharmacotherapy, 2018
Marco Fiore, Fabio Silvio Taccone, Sebastiano Leone
DAP is effective against several MDR Gram-positive pathogens, including MRSA, S. aureus strains with reduced VAN susceptibility and VRE. DAP resistance among S. aureus and Enterococcus spp. remains uncommon; however, DAP MICs for enterococci are typically one to two-fold higher than those for S. aureus and Enterococcus faecium MIC90 is generally higher than the one of Enterococcus faecalis [10]. Thus, higher than recommended DAP regimens, alone or in combination with other drugs, may be needed for the management of infectious due to MDR bacteria. DAP/beta-lactam combination is a novel treatment strategy for patients with difficult-to-treat infections, including those secondary to MRSA and VRE. This combination (e.g. DAP plus oxacillin, nafcillin, ceftaroline [CPT] or ceftobiprole against MRSA and DAP plus ampicillin [AMP], ertapenem, CPT, ceftobiprole or ceftriaxone against VRE) reduces the charge of the outer bacterial membrane, allowing for faster bacterial killing and delaying the emergence of DAP-resistant strains [11]. Some concerns about DAP are related to the optimal daily dose; in large retrospective studies on bacteraemic patients, DAP improved survival and microbiological cure only at a dose of >10 mg/kg [7]; moreover, if the origin of BSI is a lower respiratory tract infection, DAP could become ineffective due to inhibition by pulmonary surfactant [12].
How automatic notification of infectious disease specialists impacted the management of Staphylococcus aureus bacteremia in a community hospital setting
Published in Journal of Community Hospital Internal Medicine Perspectives, 2018
Nicole Roe, Michael Wang, Samuel J. Wisniewski, Richard Douce
One limitation of our study is the retrospective design. There was also a total of n = 10 patients who were transferred to tertiary care facilities and thus not all information was obtainable. Another limitation is the size of our study. The number of cases in this study limited our ability to show statistical significance. The authors recognize that there is a minimum of two days between admission of a bacteremic patient and notification of the ID specialist. There are time delays between when the culture results become positive to when the email generates every morning to when the physician reads the culture results and evaluates the patient. This is also a chronologic study. During the course of this study, several publications emerged that may have influenced the management of patients, including articles that demonstrate that cefazolin is as good as nafcillin, but with fewer severe side effects and less expense [21,22]. An additional limitation is the external generalizability of these results. Further studies replicating the methodology here with not only a larger sample size but with recruiting samples from multiple health systems and examining other possibly relevant demographics variables such as socioeconomic status (SES) and healthcare costs could expand the applicability of the results observed.
Related Knowledge Centers
- Antimicrobial Resistance
- Hypokalemia
- Oxacillin
- Infection
- Narrow-Spectrum Antibiotic
- Beta-Lactam Antibiotics
- Beta-Lactamase
- Gram-Positive Bacteria
- Species
- Staphylococcus