Intravenous nafcillin (N) or oxacillin (O) was administered to 114 patients, newborn to 17 years of age. Distribution of the pts included 87 studied double blind and 27 by physician preference. Physician preference pts did not alter the results. A minimum of five days of IV therapy was required for inclusion, but 60% of the pts received >10 days of therapy. The pts were monitored with serial CBC's, platelet counts, urinalysis, BUN, creatinine, SGOT, SGPT, and bilirubin. Occurrence of secondary fevers, rashes, and thrombophlebitis (TH) were tabulated.

Treatment courses were successful in 97.5%, but 4 pts died after bacteriologic sterilization. TH occurred in 17/52 N pts and 4/62 O pts. In pts over 10 years of age receiving N 14/25 developed TH. Of eight pts switched blindly from N to O because of TH, all tolerated the second drug. Three patients in each group developed severe neutropenia (WBC≤1500). Seven N and 5 O pts had drug fevers. Elevated SGPT's occurred in 13/62 O and 6/52 N pts. No renal side effects were noted.

Pharmacokinetic studies were done on 12 pts of which six pts had cross-over studies on both drugs. The half-life in prematures was different than the older child (3.0 ± 0.9 versus 0.6 ± 0.1 hrs.) There was no difference between O or N half-lives. Volumes of distribution, and total body clearances were calculated.

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Arbeter, A., Tolpin, M., Piercy, S. et al. 752 NAFCILLIN-OXACILLIN COMPARATIVE CLINICAL TRIAL. Pediatr Res 12, 489 (1978). https://doi.org/10.1203/00006450-197804001-00757

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