Penicillin V


  • 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


  • 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


  • 500mg PO QID

Recurrent Rheumatic Fever (Prophylaxis)

  • 250mg PO BID

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

  • 500mg BID-QID

Pediatric Dosing


  • <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


  • Allergy to class/drug

Adverse Reactions


  • Anaphylaxis
  • Interstitial nephritis
  • Seizures


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


  • 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
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


  • 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


  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