Nalidixic Acid

Indications
 Oral
Uncomplicated lower urinary tract infections
Adult: 1 g 4 times daily for 1-2 wk. Long-term therapy: Reduce daily dose to 2 g.
Child: >3 mth: 50 mg/kg daily in 4 equally divided doses. Long-term therapy: Reduce dose to 30 mg/kg daily. Prophylaxis: 15 mg/kg bid.
Renal impairment: Reduced doses should be considered.
Hepatic impairment: Reduced doses should be considered.
Oral
Shigellosis
Adult: 1 g 4 times daily for 5 days.
Child: ≥3 mth: 15 mg/kg 4 times daily for 5 days.
Renal impairment: Reduced doses should be considered.
Hepatic impairment: Reduced doses should be considered.
Contraindications
 Hypersensitivity. History of convulsive disorders or porphyria. Infants <3 mth. Severe renal impairment.
Warnings / Precautions
 Hepatic or moderate renal impairment, severe cerebral arteriosclerosis, G6PD deficiency. Monitor blood counts, renal and hepatic function for treatment >2 wk. Children <18 yr. Elderly. Avoid exposure to sunlight or sunlamps. Pregnancy and lactation.
Adverse Reactions
 Nausea, vomiting, diarrhoea, abdominal pain; photosensitivity reactions, allergic rash, urticaria, pruritus; visual disturbances, headache, dizziness or vertigo, drowsiness, confusion, depression, excitement, hallucinations, toxic psychoses or convulsions (especially after large doses), intracranial hypertension (especially in infants and young children), metabolic acidosis; peripheral neuropathies, muscular weakness, myalgia; arthralgia, tendon damage; cholestatic jaundice, thrombocytopenia, leucopenia.
Potentially Fatal: Erythema multiforme and Stevens-Johnson syndrome; anaphylactoid reactions. Auto-immune haemolytic anaemia (particularly in elderly patients).
Overdose Reactions
 Symptoms: Toxic psychosis, convulsions, increased intracranial pressure, metabolic acidosis, vomiting, nausea, lethargy. Management: Increase fluid admin; supportive measures. Anticonvulsants may be used in severe cases.
Drug Interactions
 Absorption reduced by sucralfate, and divalent and trivalent cations e.g. aluminium, calcium, iron, magnesium, zinc. Excretion reduced and plasma concentrations increased with probenecid. Reduced effects with chloramphenicol, nitrofurantoin, tetracycline.
Potentially Fatal: Fatal haemorrhagic enterocolitis may occur when used with high-dose melphalan in children. Increased risk of nephrotoxicity with ciclosporin. May increase effects of oral anticoagulants e.g. warfarin.
See Below for More nalidixic acid Drug Interactions
Lab Interactions
 May cause false-positive urinary glucose tests using copper reduction methods. May also interfere with 17-ketosteroids and ketogenic steroids determinations.
Mechanism of Actions
 Nalidixic acid is a 4-quinolone antibacterial. It interferes with the replication of bacterial DNA by inhibiting DNA gyrase activity. It acts against gram-negative bacteria including E. coli, Proteus, Klebsiella, Enterobacter, Salmonella and Shigella spp.
Absorption: Rapidly and almost completely absorbed from the GI tract. (oral); peak plasma concentrations after 1-2 hr (oral).
Distribution: Crosses the placenta; enters the breast milk. Protein-binding: 93% (nalidixic acid); 63% (hydroxynalidixic acid).
Metabolism: Partially converted in the liver to hydroxynalidixic acid.
Excretion: Via urine (80-90% as inactive metabolites); faeces (4%); 1-2.5 hr (elimination half-life).
Administration
 Should be taken with food.
Storage Conditions
 Oral: Store at room temperature, up to 25°C (77°F).
ATC Classification
 J01MB02 - nalidixic acid ; Belongs to the class of other quinolones. Used in the systemic treatment of infections.
Storage
 Oral: Store at room temperature, up to 25°C (77°F).
Available As
  • Nalidixic Acid 1000 mg
  • Nalidixic Acid 125 mg
  • Nalidixic Acid 150 mg
  • Nalidixic Acid 250 mg
  • Nalidixic Acid 300 mg
  • Nalidixic Acid 500 mg

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