Penicillin: Difference between revisions
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− | == |
+ | ==Background== |
− | === |
+ | === Nomenclature === |
+ | * Broadly speaking, formulations of penicillin G are soluble and used for IV or IM administration, and penicillin V is used for oral administration but does not achieve high levels in the serum |
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− | * Directly inhibits [[Penicillin-binding protein|penicillin-binding proteins]] |
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+ | {| class="wikitable" |
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+ | !Formulation |
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+ | !Other Names |
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+ | !Comments |
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+ | |- |
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+ | |sodium penicillin G |
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+ | |sodium benzylpenicillin |
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+ | crystalline penicillin |
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+ | |soluble, used for IV |
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+ | |- |
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+ | |procaine penicillin G |
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+ | |procaine benzylpenicillin |
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+ | procaine penicilli |
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+ | |less soluble, used for IM |
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+ | |- |
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+ | |benzathine penicillin G |
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+ | |DBED penicillin |
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+ | |less soluble than procaine, used for IM |
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+ | |- |
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+ | |penicillin V |
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+ | |phenoxymethylpenicillin |
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+ | |used for PO, but poor absorption |
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+ | |} |
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+ | |||
+ | ===Mechanism of Action=== |
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+ | |||
+ | *Directly inhibits [[Penicillin-binding protein|penicillin-binding proteins]] |
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+ | |||
+ | === Spectrum of Activity === |
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+ | |||
+ | * Generally active against Gram-positive cocci, especially [[streptococci]] but some strains of [[Staphylococcus aureus]], most [[clostridia]], [[Neisseria species]], and some [[Haemophilus influenzae]] |
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+ | * Not active against aerobic Gram-negative bacilli |
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+ | * Penicillin G is generally more active than penicillin V across all bacteria |
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+ | |||
+ | === Clinical Breakpoints === |
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+ | {| class="wikitable" |
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+ | ! rowspan="2" |Species |
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+ | ! colspan="3" |Breakpoints (μg/mL) |
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+ | ! colspan="3" |Breakpoints (mm) |
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+ | |- |
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+ | !S |
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+ | !I |
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+ | !R |
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+ | !S |
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+ | !I |
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+ | !R |
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+ | |- |
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+ | |[[Anaerobes]] except [[Bacteroides]] |
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+ | |≤0.5 |
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+ | |1 |
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+ | |≥2 |
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+ | | |
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+ | | |
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+ | | |
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+ | |- |
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+ | |[[Enterococcus species]] |
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+ | |≤8 |
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+ | | |
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+ | |≥16 |
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+ | |≥15 |
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+ | | |
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+ | |≤14 |
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+ | |- |
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+ | |[[Neisseria gonorrhoeae]] |
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+ | |≤0.06 |
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+ | |0.12-1 |
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+ | |≥2 |
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+ | |≥47 |
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+ | |27-46 |
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+ | |≤26 |
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+ | |- |
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+ | |[[Neisseria meningitidis]] |
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+ | |≤0.06 |
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+ | |0.12-0.25 |
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+ | |≥0.5 |
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+ | | |
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+ | | |
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+ | | |
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+ | |- |
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+ | |[[Staphylococcus species]] |
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+ | |≤0.12 |
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+ | | |
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+ | |≥0.25 |
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+ | |≥29 |
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+ | | |
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+ | |≤28 |
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+ | |- |
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+ | |[[Streptococcus pneumoniae]] |
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+ | | |
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+ | | |
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+ | | |
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+ | |≥20 |
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+ | | |
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+ | | |
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+ | |- |
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+ | |[[Streptococcus pneumoniae]] IV (nonmeningitis) |
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+ | |≤2 |
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+ | |4 |
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+ | |≥8 |
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+ | | |
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+ | | |
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+ | | |
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+ | |- |
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+ | |[[Streptococcus pneumoniae]] IV (meningitis) |
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+ | |≤0.06 |
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+ | | |
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+ | |≥0.12 |
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+ | | |
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+ | | |
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+ | | |
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+ | |- |
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+ | |[[Streptococcus pneumoniae]] PO (pen V) |
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+ | |≤0.06 |
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+ | |0.12-1 |
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+ | |≥2 |
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+ | | |
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+ | | |
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+ | | |
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+ | |- |
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+ | |[[Streptococcus species]] (β-hemolytic) |
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+ | |≤0.12 |
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+ | | |
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+ | | |
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+ | |≥24 |
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+ | | |
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+ | | |
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+ | |- |
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+ | |[[Streptococcus species]] (viridans group) |
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+ | |≤0.12 |
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+ | |0.25-2 |
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+ | |≥4 |
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+ | | |
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+ | | |
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+ | | |
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+ | |} |
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[[Category:Beta-lactams]] |
[[Category:Beta-lactams]] |
Revision as of 11:19, 13 September 2020
Background
Nomenclature
- Broadly speaking, formulations of penicillin G are soluble and used for IV or IM administration, and penicillin V is used for oral administration but does not achieve high levels in the serum
Formulation | Other Names | Comments |
---|---|---|
sodium penicillin G | sodium benzylpenicillin
crystalline penicillin |
soluble, used for IV |
procaine penicillin G | procaine benzylpenicillin
procaine penicilli |
less soluble, used for IM |
benzathine penicillin G | DBED penicillin | less soluble than procaine, used for IM |
penicillin V | phenoxymethylpenicillin | used for PO, but poor absorption |
Mechanism of Action
- Directly inhibits penicillin-binding proteins
Spectrum of Activity
- Generally active against Gram-positive cocci, especially streptococci but some strains of Staphylococcus aureus, most clostridia, Neisseria species, and some Haemophilus influenzae
- Not active against aerobic Gram-negative bacilli
- Penicillin G is generally more active than penicillin V across all bacteria
Clinical Breakpoints
Species | Breakpoints (μg/mL) | Breakpoints (mm) | ||||
---|---|---|---|---|---|---|
S | I | R | S | I | R | |
Anaerobes except Bacteroides | ≤0.5 | 1 | ≥2 | |||
Enterococcus species | ≤8 | ≥16 | ≥15 | ≤14 | ||
Neisseria gonorrhoeae | ≤0.06 | 0.12-1 | ≥2 | ≥47 | 27-46 | ≤26 |
Neisseria meningitidis | ≤0.06 | 0.12-0.25 | ≥0.5 | |||
Staphylococcus species | ≤0.12 | ≥0.25 | ≥29 | ≤28 | ||
Streptococcus pneumoniae | ≥20 | |||||
Streptococcus pneumoniae IV (nonmeningitis) | ≤2 | 4 | ≥8 | |||
Streptococcus pneumoniae IV (meningitis) | ≤0.06 | ≥0.12 | ||||
Streptococcus pneumoniae PO (pen V) | ≤0.06 | 0.12-1 | ≥2 | |||
Streptococcus species (β-hemolytic) | ≤0.12 | ≥24 | ||||
Streptococcus species (viridans group) | ≤0.12 | 0.25-2 | ≥4 |