Nalidixic Acid

	Zambia HIV National Guidelines
	Introduction HIV Counseling and Testing Sexually Transmitted Infections (STIs) General Principles of Antiretroviral Therapy for Chronic HIV Infection in Adults and Adolescents When to Start ARV Therapy for Chronic HIV Infection in Adults and Adolescents Initial Regimen for ARV Therapy Adherence Baseline evaluation and Monitoring Calculations: Ideal Body Weight, Body Mass Index and Creatinine Clearance ARV Therapy for Individuals with Tuberculosis Co-Infection Adverse Effects and Toxicity Immune Reconstitution Inflammatory Syndrome (IRIS) Changing or Stopping ART Treatment Failure Stopping ARV Therapy Post Exposure Prophylaxis Cotrimoxazole Prophylaxis WHO Staging in Adults and Adolescents Nutrition Care and Support Palliative Care in HIV and AIDS
	Guide Editors
	Editor In Chief Joel E. Gallant, MD, MPH Pharmacology Editor Paul Pham, PharmD, BCPS Zambia Guideline Team Peter Mwaba MMed PhD FRCP Alywn Mwinga MMed Isaac Zulu MMed MPH Velepie Mtonga MMed Albert Mwango MBChB Jabbin Mulwanda MMed FCS

Drugs>Antimicrobial Agents>

Nalidixic Acid

Paul A. Pham Pharm.D. and John G. Bartlett M.D.
03-17-2009

Zambia Specific Information

Available formulation in Zambia: Tablet: 500 mg
Use should be limited to uncomplicated UTIs
Increased incidence of side effects compared to fluoroquinolones (e.g GI intolerance, photosensitivity, LFTs elevation).
Uncomplicated UTI: 1gm q6h x 7 days in acute infections. If therapy prolonged, as in the treatment of chronic or persistent infections, dose may be reduced to 2 g/d.

REFERENCES

Zambia Information Author: Paul A. Pham, Pharm. D.

INDICATIONS

FDA

No longer available in the U.S.

NON-FDA APPROVED USES

Urinary tract infections

FORMS

brand name	generic	Mfg	brand forms	cost*
NegGram	Nalidixic Acid		oral tablet 250mg	N/A
			oral tablet 500mg	N/A

*Prices represent cost per unit specified and are representative of "Average Wholesale Price" (AWP). AWP Prices were obtained and gathered by Lakshmi Vasist Pharm D using the Red Book, manufacturer's information, and the McKesson database.

^Dosage is indicated in mg unless otherwise noted.

USUAL ADULT DOSING

Uncomplicated UTI: 1gm PO q6h.

RENAL DOSING

DOSING FOR GLOMERULAR FILTRATION OF 50-80

Usual dose.

DOSING FOR GLOMERULAR FILTRATION OF 10-50

Usual dose.

DOSING FOR GLOMERULAR FILTRATION OF <10 ML/MIN

Avoid due to inadequate urinary level and potential monoglucuronide metabolite toxicity.

DOSING IN HEMODIALYSIS

Avoid due to inadequate urinary level and potential monoglucuronide metabolite toxicity.

DOSING IN PERITONEAL DIALYSIS

Avoid due to inadequate urinary level and potential monoglucuronide metabolite toxicity.

DOSING IN HEMOFILTRATION

Avoid due to inadequate urinary level and potential monoglucuronide metabolite toxicity.

ADVERSE DRUG REACTIONS

GENERAL

Higher incidence of side effects compared to other members of the quinolone class.

OCCASIONAL

GI intolerance, diarrhea
CNS: headache, malaise, insomnia, restlessness, dizziness
Allergic reactions
Photosensitivity reactions
Liver enzymes elevation

RARE

Tendon rupture (higher risk with steroid use)
QTc prolongation (class effect)
C. difficile associated diarrhea

DRUG INTERACTIONS

Divalent and trivalent cations [vitamins and minerals (e.g., calcium, zinc and iron), antacids (magnesium, aluminum, calcium) and sucralfate]: decreases nalidixic acid absorption. Avoid co-administration or administer nalidixic acid 2 hours before cationic compound.

SPECTRUM

E. coli and other urinary pathogens. Poor activity against pseudomonas.

PHARMACOLOGY

Pharmacology

COMMENTS

First oral quinolone, FDA approved in 1962. Used primarily for urinary tract infection, but due to the increased incidence of side effects and four times a day dosing, better agents should be used. U.S. manufacturer discontinued production.

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Abbreviations