Nafcillin extravasation injury. Use of hyaluronidase as an antidote

Subcutaneous extravasation of parenteral nafcillin sodium can cause deep-tissue necrosis, sometimes necessitating multiple debridements and skin grafting. We report two cases in which nafcillin-induced tissue injury was successfully prevented by prompt clysis of hyaluronidase to the site of infiltration; these patients are compared with an infant in whom hyaluronidase was not used and in whom full-thickness skin loss resulted. Hyaluronidase is an enzyme that reduces or prevents tissue injury by causing the rapid diffusion of extravasated fluids through tissues by temporarily destroying tissue cement, thus increasing absorptive surface and the resultant rate of absorption. We have found that hyaluronidase, when used promptly after an extravasation has occurred, is effective in markedly reducing the amount of local tissue damage and destruction caused by the infiltration of nafcillin.