Antimicrobial Use Guidelines (AMUG) version 21 - UW Health

NAFCILLINNafcillin and oxacillin are therapeutically interchangeable at the UWHC. Oxacillin is the current formulary choice.Usual DoseAdult: 1 - 2 g Q4H IV (UWHC cost/day $51.42-99.48).Pediatric:** 150-200 mg/kg/day IV in divided doses Q4H.Indications1. Staphylococcus aureus infections sensitive to oxacillin.2. Skin and soft tissue infections due to Staphylococcus or group A streptococcus.3. Empiric therapy of community-acquired Gram-positive skin and soft-tissue infections.CommentsCAUTION: None of the semi-synthetic penicillins are effective against enterococci, methicillin-resistant S aureus,methicillin-resistant coagulase-negative staphylococci, Gram-negative bacilli or Bacteroides fragilis. For endocarditis, thedose is 1.5 - 2 g Q4H IV or 9 -12 g/24H by continuous infusion. For IV administration, lidocaine 10 mg/1 mL may be addedto nafcillin to decrease phlebitis.Drug Interactions• Warfarin – concurrent administration with warfarin causes decreased anticoagulation.• Cyclosporine – nafcillin decreases cyclosporine concentrations or interferes with assay• Aminoglycosides – inactivated by penicillins in admixtures when penicillin:AG ratio is 50:1 or higher• Nifedipine – decreased AUC due to induced metabolism at CYP 3A isoenzymes by nafcillin• Live typhoid vaccine – decreased efficacy; wait 24 hours after end of therapy to give vaccineNELFINAVIRFor up-to-date information on the use of antiretrovirals, consult an HIV expert or www.aidsinfo.nih.gov/NEVIRAPINEFor up-to-date information on the use of antiretrovirals, consult an HIV expert or www.aidsinfo.nih.gov/NITAZOXANIDE (Alinia ® )Usual DoseAdult: 500 mg Q12-24H PO (UWHC cost/day $19.91-$39.82).Pediatric: Ages 12-47 months: 100 mg Q12H PO; Ages 4-11 years: 200 mg Q12H PO (UWHC cost/day $12.85-25.70);Ages 12 and over: 500 mg Q12H PO.Indications1. Cryptosporidiosis in patients 1 year old and older.2. Giardiasis in patients 1 year old and older.CommentsProduct is available as a 500 mg tablet or a 100 mg/5 mL suspension; suspension contains 1.48 g sucrose/5 mL. No datain hepatic or renal impairment. Safety and efficacy in immunocompromised patients have not been established.NITROFURANTOINUsual DoseAdult: Treatment generic nitrofurantoin 50-100 mg Q6H PO (UWHC cost/day $1.46-1.90) OR Macrobid ® 100 mg BID PO(UWHC cost/day $6.89).Prophylaxis for UTI 50 mg HS PO.Pediatric:** Treatment 5-7 mg/kg/day PO in divided dosesProphylaxis 1 mg/kg/day