Penicillin: Difference between revisions
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==Background== |
==Background== |
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+ | ===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]] |
*Directly inhibits [[Penicillin-binding protein|penicillin-binding proteins]] |
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− | === |
+ | ===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=== |
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! rowspan="2" |Species |
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+ | == Safety == |
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+ | |||
+ | === Adverse Events === |
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+ | |||
+ | ==== Hypersensitivity Reactions ==== |
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+ | |||
+ | * Can cause any type of [[hypersensitivity reaction]] (I to IV) |
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+ | * Type I: [[anaphylaxis]] and [[urticaria]] |
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+ | * Type II: [[autoimmune hemolytic anemia]] |
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+ | * Type III: [[serum sickness-like reaction]] |
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+ | * Type IV: |
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+ | ** Delayed maculopapular drug rash |
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+ | *** Usually after 7 to 10 days of starting and up to 1 to 3 days after stopping) |
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+ | *** Progresses over days, with lesions that are relatively fixed |
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+ | *** Can worsen over a few days after stopping, then resolves over 1 to 2 weeks |
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+ | *** Pruritis is variable |
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+ | *** Most commonly occur in the context of a viral infection |
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+ | ** [[Contact dermatitis]] |
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+ | |||
[[Category:Beta-lactams]] |
[[Category:Beta-lactams]] |
Revision as of 14:21, 25 February 2021
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 |
Safety
Adverse Events
Hypersensitivity Reactions
- Can cause any type of hypersensitivity reaction (I to IV)
- Type I: anaphylaxis and urticaria
- Type II: autoimmune hemolytic anemia
- Type III: serum sickness-like reaction
- Type IV:
- Delayed maculopapular drug rash
- Usually after 7 to 10 days of starting and up to 1 to 3 days after stopping)
- Progresses over days, with lesions that are relatively fixed
- Can worsen over a few days after stopping, then resolves over 1 to 2 weeks
- Pruritis is variable
- Most commonly occur in the context of a viral infection
- Contact dermatitis
- Delayed maculopapular drug rash