Penicillin V: Difference between revisions
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==General==
==General==
*Type: Natural [[Penicillin]]
*Type: [[Is PenicillinType::Natural]] [[Is DrugClass::Penicillin]]
*Dosage Forms: PO 250mg, 500mg; 125mg/5mL, 250 mg/5 mL
*Dosage Forms: PO 250mg, 500mg; 125mg/5mL, 250mg/5 mL
*Common Trade Names:
*Common Trade Names:


==Adult Dosing==
==Adult Dosing==
===[[Strep Pharyngitis]]<ref>9.Shulman ST, Bisno AL, Clegg HW, et al; Infectious Diseases Society of America. Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America. Clin Infect Dis, 2012, 55(10):e86-102. PubMed 22965026</ref>===
===[[Strep Pharyngitis]]<ref>Shulman ST, Bisno AL, Clegg HW, et al; Infectious Diseases Society of America. Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America. Clin Infect Dis, 2012, 55(10):e86-102. PubMed 22965026</ref>===
*Acute
*Acute
**250mg QID or 500mg BID x 10 days  
**250mg QID or 500mg BID x 10 days  
*Chronic carrier (Group A)
*Chronic carrier (Group A)
**500mg QID x 10 days + rifampin
**500mg QID x 10 days + rifampin
**Max: 2000 mg/day
**Max: 2000mg/day


===Actinomycosis===
===Actinomycosis===
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**2000-4000mg PO divided q6 hours x 8 weeks
**2000-4000mg PO divided q6 hours x 8 weeks
*Surgical
*Surgical
**I.V. [[Penicillin G]] x 4-6 weeks, then 2000-4000 mg PO divided q6h x 6-12 months
**I.V. [[Penicillin G]] x 4-6 weeks, then 2000-4000mg PO divided q6h x 6-12 months


===[[Erysipelas]]===
===[[Erysipelas]]===
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*250mg PO BID
*250mg PO BID


===Prosthetic Joint Infection (Offlabel), Chronic Suppression<ref>7.Osmon DR, Berbari EF, Berendt AR, et al, “Diagnosis and Management of Prosthetic Joint Infection: Clinical Practice Guideline by the Infectious Diseases Society of America,” Clin Infect Dis, 2013, 56(1):e1-25. PubMed 23223583</ref>===
===Prosthetic Joint Infection, Chronic Suppression (Off-Label)<ref>Osmon DR, Berbari EF, Berendt AR, et al, “Diagnosis and Management of Prosthetic Joint Infection: Clinical Practice Guideline by the Infectious Diseases Society of America,” Clin Infect Dis, 2013, 56(1):e1-25. PubMed 23223583</ref>===
*500mg BID-QID
*500mg BID-QID


==Pediatric Dosing==
==Pediatric Dosing==
===General===
*'''<12 years'''
**25-50mg/kg/day divided q6-8 hours
**Max: 2000mg/day
*≥12 years
**125-500mg q6-8 hours
**Alt: 25-50mg/kg/day divided q6-8 hours
**Max: 2000mg/day
===[[Strep Pharyngitis]]===
*Acute<ref>Gerber, 2009; Shulman, 2012; WHO, 2004</ref>
**≤27kg: 250mg BID-TID x 10 days
**>27kg: 500mg BID-TID x 10 days
*Chronic Carrier ([[Group A streptococci]]
**50mg/kg/day divided q6 hours x 10 days + [[rifampin]]
**Max: 2000mg/day<ref>Shulman, 2012</ref>
*Recurrent Rheumatic Fever, prophylaxis
**250mg BID<ref>4.Gerber MA, Baltimore RS, Eaton CB, et al, "Prevention of Rheumatic Fever and Diagnosis and Treatment of Acute Streptococcal pharyngitis: A Scientific Statement from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young, the Interdisciplinary Council on Functional Genomics and Translational Biology, and the Interdisciplinary Council on Quality of Care and Outcomes Research: Endorsed by the American Academy of Pediatrics," Circulation, 2009, 119(11):1541-51. PubMed 19246689</ref>
===[[Anthrax]] (Cutaneous)===
*25-50mg/kg/day divided BID-QID
*Max: 500mg per dose (Stevens, 2005)
===[[Pneumonia]], Community-Acquired (>3 Months)<ref>Bradley JS, Byington CL, Shah SS, et al. The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clin Infect Dis. 2011;53(7):e25-76. [PubMed 21880587]</ref>===
*50-75mg/kg/day divided q6-8h hours
*Max: 2000mg/day


==Special Populations==
==Special Populations==
*[[Drug Ratings in Pregnancy|Pregnancy Rating]]:
*[[Drug Ratings in Pregnancy|Pregnancy Rating]]: B
*Lactation:
*Lactation: Safe
*Renal Dosing
*Renal Dosing
**Adult
**Adult
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==Adverse Reactions==
==Adverse Reactions==
===Serious===
===Serious===
 
*Anaphylaxis
*Interstitial nephritis
*Seizures
===Common===
===Common===
*Nausea, diarrhea
*Oral candidiasis
*Anemia
*Positive Coombs reaction


==Pharmacology==
==Pharmacology==
*Half-life:  
*Half-life: 0.5-0.6hr
*Metabolism:  
*Metabolism: Hepatic
*Excretion:  
*Excretion: urinary
*Mechanism of Action:
*Mechanism of Action: Inhibits the biosynthesis of cell wall mucopeptide
 
==[[Antibiotic Sensitivities]]<ref>Sanford Guide to Antimicrobial Therapy 2014</ref>==
{| class="wikitable"
| align="center" style="background:#f0f0f0;"|'''Group'''
| align="center" style="background:#f0f0f0;"|'''Organism'''
| align="center" style="background:#f0f0f0;"|'''Sensitivity'''
|-
| Gram Positive||[[Strep. Group A, B, C, G]]||'''S'''
|-
| ||[[Strep. Pneumoniae]]||'''S'''
|-
| ||[[Viridans strep]]||I
|-
| ||Strep. anginosus gp||'''S'''
|-
| ||[[Enterococcus faecalis]]||'''S'''
|-
| ||[[Enterococcus faecium]]||I
|-
| ||[[MSSA]]||R
|-
| ||[[MRSA]]||R
|-
| ||[[CA-MRSA]]||R
|-
| ||[[Staph. Epidermidis]]||R
|-
| ||[[C. jeikeium]]||R
|-
| ||[[L. monocytogenes]]||R
|-
| Gram Negatives||[[N. gonorrhoeae]]||R
|-
| ||[[N. meningitidis]]||R
|-
| ||[[Moraxella catarrhalis]]||R
|-
| ||[[H. influenzae]]||R
|-
| ||[[E. coli]]||R
|-
| ||[[Klebsiella]] sp||R
|-
| ||E. coli/Klebsiella ESBL+||R
|-
| ||E coli/Klebsiella KPC+||R
|-
| ||[[Enterobacter]] sp, AmpC neg||R
|-
| ||[[Enterobacter]] sp, AmpC pos||R
|-
| ||[[Serratia]] sp||R
|-
| ||Serratia marcescens||X1
|-
| ||[[Salmonella]] sp||R
|-
| ||[[Shigella]] sp||R
|-
| ||[[Proteus mirabilis]]||R
|-
| ||[[Proteus vulgaris]]||R
|-
| ||[[Providencia sp.]]||R
|-
| ||[[Morganella sp.]]||R
|-
| ||[[Citrobacter freundii]]||R
|-
| ||[[Citrobacter diversus]]||R
|-
| ||[[Citrobacter sp.]]||R
|-
| ||[[Aeromonas sp]]||R
|-
| ||[[Acinetobacter sp.]]||R
|-
| ||[[Pseudomonas aeruginosa]]||R
|-
| ||[[Burkholderia cepacia]]||R
|-
| ||[[Stenotrophomonas maltophilia]]||R
|-
| ||[[Yersinia enterocolitica]]||R
|-
| ||[[Francisella tularensis]]||X1
|-
| ||[[Brucella sp.]]||X1
|-
| ||[[Legionella sp.]]||R
|-
| ||[[Pasteurella multocida]]||'''S'''
|-
| ||[[Haemophilus ducreyi]]||X1
|-
| ||[[Vibrio vulnificus]]||X1
|-
| Misc||[[Chlamydophila sp]]||R
|-
| ||[[Mycoplasm pneumoniae]]||R
|-
| ||[[Rickettsia sp]]||X1
|-
| ||[[Mycobacterium avium]]||X1
|-
| Anaerobes||[[Actinomyces]]||I
|-
| ||[[Bacteroides fragilis]]||I
|-
| ||[[Prevotella melaninogenica]]||R
|-
| ||[[Clostridium difficile]]||X1
|-
| ||[[Clostridium (not difficile)]]||'''S'''
|-
| ||[[Fusobacterium necrophorum]]||I
|-
| ||[[Peptostreptococcus sp.]]||'''S'''
|}
 
===Key===
{{Template:Antibacterial Spectra Key}}


==See Also==
==See Also==
*[[Antibiotics (Main)]]
*[[Antibiotics (Main)]]


==Source==
==References==
<references/>


<references/>
[[Category:Pharmacology]]
[[Category:Drugs]]
[[Category:ID]]

Latest revision as of 17:32, 18 July 2025

General

  • Type: Natural Penicillin
  • Dosage Forms: PO 250mg, 500mg; 125mg/5mL, 250mg/5 mL
  • Common Trade Names:

Adult Dosing

Strep Pharyngitis[1]

  • Acute
    • 250mg QID or 500mg BID x 10 days
  • Chronic carrier (Group A)
    • 500mg QID x 10 days + rifampin
    • Max: 2000mg/day

Actinomycosis

  • Mild
    • 2000-4000mg PO divided q6 hours x 8 weeks
  • Surgical
    • I.V. Penicillin G x 4-6 weeks, then 2000-4000mg PO divided q6h x 6-12 months

Erysipelas

  • 500mg PO QID

Recurrent Rheumatic Fever (Prophylaxis)

  • 250mg PO BID

Prosthetic Joint Infection, Chronic Suppression (Off-Label)[2]

  • 500mg BID-QID

Pediatric Dosing

General

  • <12 years
    • 25-50mg/kg/day divided q6-8 hours
    • Max: 2000mg/day
  • ≥12 years
    • 125-500mg q6-8 hours
    • Alt: 25-50mg/kg/day divided q6-8 hours
    • Max: 2000mg/day

Strep Pharyngitis

  • Acute[3]
    • ≤27kg: 250mg BID-TID x 10 days
    • >27kg: 500mg BID-TID x 10 days
  • Chronic Carrier (Group A streptococci
    • 50mg/kg/day divided q6 hours x 10 days + rifampin
    • Max: 2000mg/day[4]
  • Recurrent Rheumatic Fever, prophylaxis

Anthrax (Cutaneous)

  • 25-50mg/kg/day divided BID-QID
  • Max: 500mg per dose (Stevens, 2005)

Pneumonia, Community-Acquired (>3 Months)[6]

  • 50-75mg/kg/day divided q6-8h hours
  • Max: 2000mg/day

Special Populations

  • Pregnancy Rating: B
  • Lactation: Safe
  • Renal Dosing
    • Adult
    • Pediatric
  • Hepatic Dosing
    • Adult
    • Pediatric

Contraindications

  • Allergy to class/drug

Adverse Reactions

Serious

  • Anaphylaxis
  • Interstitial nephritis
  • Seizures

Common

  • Nausea, diarrhea
  • Oral candidiasis
  • Anemia
  • Positive Coombs reaction

Pharmacology

  • Half-life: 0.5-0.6hr
  • Metabolism: Hepatic
  • Excretion: urinary
  • Mechanism of Action: Inhibits the biosynthesis of cell wall mucopeptide

Antibiotic Sensitivities[7]

Group Organism Sensitivity
Gram Positive Strep. Group A, B, C, G S
Strep. Pneumoniae S
Viridans strep I
Strep. anginosus gp S
Enterococcus faecalis S
Enterococcus faecium I
MSSA R
MRSA R
CA-MRSA R
Staph. Epidermidis R
C. jeikeium R
L. monocytogenes R
Gram Negatives N. gonorrhoeae R
N. meningitidis R
Moraxella catarrhalis R
H. influenzae R
E. coli R
Klebsiella sp R
E. coli/Klebsiella ESBL+ R
E coli/Klebsiella KPC+ R
Enterobacter sp, AmpC neg R
Enterobacter sp, AmpC pos R
Serratia sp R
Serratia marcescens X1
Salmonella sp R
Shigella sp R
Proteus mirabilis R
Proteus vulgaris R
Providencia sp. R
Morganella sp. R
Citrobacter freundii R
Citrobacter diversus R
Citrobacter sp. R
Aeromonas sp R
Acinetobacter sp. R
Pseudomonas aeruginosa R
Burkholderia cepacia R
Stenotrophomonas maltophilia R
Yersinia enterocolitica R
Francisella tularensis X1
Brucella sp. X1
Legionella sp. R
Pasteurella multocida S
Haemophilus ducreyi X1
Vibrio vulnificus X1
Misc Chlamydophila sp R
Mycoplasm pneumoniae R
Rickettsia sp X1
Mycobacterium avium X1
Anaerobes Actinomyces I
Bacteroides fragilis I
Prevotella melaninogenica R
Clostridium difficile X1
Clostridium (not difficile) S
Fusobacterium necrophorum I
Peptostreptococcus sp. S

Key

  • S susceptible/sensitive (usually)
  • I intermediate (variably susceptible/resistant)
  • R resistant (or not effective clinically)
  • S+ synergistic with cell wall antibiotics
  • U sensitive for UTI only (non systemic infection)
  • X1 no data
  • X2 active in vitro, but not used clinically
  • X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
  • X4 active in vitro, but not clinically effective for strep pneumonia

See Also

References

  1. ↑ Shulman ST, Bisno AL, Clegg HW, et al; Infectious Diseases Society of America. Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America. Clin Infect Dis, 2012, 55(10):e86-102. PubMed 22965026
  2. ↑ Osmon DR, Berbari EF, Berendt AR, et al, “Diagnosis and Management of Prosthetic Joint Infection: Clinical Practice Guideline by the Infectious Diseases Society of America,” Clin Infect Dis, 2013, 56(1):e1-25. PubMed 23223583
  3. ↑ Gerber, 2009; Shulman, 2012; WHO, 2004
  4. ↑ Shulman, 2012
  5. ↑ 4.Gerber MA, Baltimore RS, Eaton CB, et al, "Prevention of Rheumatic Fever and Diagnosis and Treatment of Acute Streptococcal pharyngitis: A Scientific Statement from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young, the Interdisciplinary Council on Functional Genomics and Translational Biology, and the Interdisciplinary Council on Quality of Care and Outcomes Research: Endorsed by the American Academy of Pediatrics," Circulation, 2009, 119(11):1541-51. PubMed 19246689
  6. ↑ Bradley JS, Byington CL, Shah SS, et al. The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clin Infect Dis. 2011;53(7):e25-76. [PubMed 21880587]
  7. ↑ Sanford Guide to Antimicrobial Therapy 2014
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