Nalidixic Acid

A to Z Drug Facts

Nalidixic Acid

	Action
	Indications
	Contraindications
	Route/Dosage
	Interactions
	Lab Test Interferences
	Adverse Reactions
	Precautions
Patient Care Considerations
	Administration/Storage
	Assessment/Interventions
	Patient/Family Education

(nal-ih-DIK-sik acid)

NegGram

Class: Urinary anti-infective

Action Interferes with DNA formation of certain bacteria.

Indications Treatment of UTIs caused by susceptible gram-negative bacteria, including most Proteus strains, Klebsiella and Enterobacter species and E. coli.

Contraindications History of seizures.

Route/Dosage

ADULTS: PO Initial therapy: 1 g qid for 1 or 2 wk. Prolonged Therapy: 1 g bid after initial therapy. Children 3 mo to 2 YR: PO Initial therapy: 55 mg/kg/day divided into 4 equal doses. Prolonged Therapy: 33 mg/kg/day in 4 divided doses after initial therapy.

Interactions

Oral anticoagulants: May enhance anticoagulant effect.

Lab Test Interferences False-positive urinary glucose results with Benedict's or Fehling's solutions or Clinitest reagent tablets; use Clinistix or Tes-tape. Urinary 17-keto and ketogenic steroids may be falsely elevated; Porter-Silber method should be used.

Adverse Reactions

CNS: Drowsiness; weakness; headache; dizziness; vertigo; seizures; intracranial hypertension; increased intracranial pressure; sixth cranial nerve palsy in children and infants. DERM: Rash; pruritus; urticaria; angioedema; photosensitivity. EENT: Visual disturbances. GI: Abdominal pain; nausea; vomiting; diarrhea. HEMA: Thrombocytopenia; leukopenia, eosinophilia or hemolytic anemia (associated with G-6-PD deficiency or acute nalidixi reaction). HEPA: Cholestatic jaundice; cholestasis. META: Metabolic acidosis.

Precautions

Pregnancy: Pregnancy category undetermined. Do not use during first trimester. Lactation: Excreted in breast milk. Children: Use drug with caution in prepubertal children; may affect cartilage and joints. CNS effects: Convulsions, increased intracranial pressure and toxic psychosis may occur with overdose or predisposing factors (eg, epilepsy, cerebral arteriosclerosis). Hematologic: Can produce clinically significant hemolysis in patients with G-6-PD deficiency. Renal failure: Patients with compromised renal function may fail to accumulate nalidixic acid, decreasing its effectiveness.

PATIENT CARE CONSIDERATIONS

Administration/Storage

Give medication ³ 1 hr before meals.
Shake suspension well before use.
Store in tightly-closed container at room temperature. Do not freeze.

Assessment/Interventions

Obtain patient history, including drug history and any known allergies.
Obtain baseline assessments of burning/pain with urination, urinary urgency or frequency, level of consciousness.
Assess for adverse reactions, primarily with CNS and GI systems.
Obtain urine specimens as needed for culture and sensitivity.
Monitor blood counts, liver and renal function test values if treatment is continued longer than 2 wk.
Re-evaluate patient for improvement of symptoms.

OVERDOSAGE: SIGNS & SYMPTOMS
	Increased intracranial pressure, metabolic acidosis, lethargy, psychosis, nausea, hyperglycemia, convulsions, vomiting

Patient/Family Education

Tell patient to take with food or milk.
Explain importance of adequate hydration and encourage intake of 1500 to 3000 mL fluids/day, unless otherwise specified by physician.
Instruct patient to report the following symptoms to physician: If no improvement of UTI discomfort, signs or symptoms 48 hours after initiation of treatment and if adverse effects occur.
Advise patient that drug may cause drowsiness or dizziness and to use caution while driving or performing other tasks requiring mental alertness.
Caution patient to avoid exposure to ultraviolet light and sunlight and to use sunscreen or wear protective clothing and to use sunglasses when outdoors. Explain that photosensitivity may last up to 3 mo after last dose.