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Penicillin V

Penicillin V 
(Phenoxymethyl Penicillin, Penicillin V Potassium)



Class:
Antibiotic, Penicillin
Action Inhibits mucopeptide synthesis of bacterial cell wall.
Indications Treatment of upper respiratory tract infections
; treatment of pneumococcal, streptococci, and staphylococcal infections and fusospirochetosis (Vincent's infection) of oropharynx caused by susceptible microorganisms.
Prophylactic treatment of sickle cell anemia in children;
 treatment of anaerobic infections; treatment of Lyme disease (Borrelia burgdorferi).
Contraindications Hypersensitivity to penicillins. 
Do not treat severe pneumonia, empyema, bacteremia, pericarditis, meningitis, and purulent or septic arthritis with oral penicillin V during acute stage.
Route/Dosage
Adults and Children over 12 yr: PO 125 to 500 mg qid.
Dose
. 500 mg every 6 hours increased up to 1 g every 6
hours in severe infections;
CHILD up to 1 year 62.5 mg
every 6 hours, increased up to 12.5 mg/kg every 6
hours in severe infections;
 1–6 years, 125 mg every 6
hours, increased up to 12.5 mg/kg every 6 hours in
severe infections; 6–12 years, 250 mg every 6 hours,
increased up to 12.5 mg/kg every 6 hours in severe
infections
Interactions
Beta-blockers: May potentiate anaphylactic reactions of penicillin.
 Contraceptives, oral: May reduce efficacy of oral contraceptives.
 Erythromycin: May cause synergism or antagonism to develop.  
Tetracyclines: May impair bactericidal effects of penicillin V.
Lab Test Interferences
Antiglobulin (Coombs') test: Drug may cause false-positive results.
Urine glucose test: Drug may cause false-positive results with copper sulfate tests (Benedict's test, Fehling's test or Clinitest tablets); enzyme-based tests (eg, Clinistix, Tes-tape) are not affected.
Urine protein determinations: Drug may cause false-positive reactions with sulfosalicylic acid and boiling test, acetic acid test, biuret reaction and nitric acid test; bromphenol blue test (Multi-Stix) is not affected.
Adverse Reactions
CNS: Dizziness; fatigue; insomnia; reversible hyperactivity; neurotoxicity (eg, lethargy, neuromuscular irritability, hallucinations, convulsions, seizures). EENT: Itchy eyes; furry tongue; black “hairy” tongue; stomatitis; sore mouth or tongue. GI: Glossitis; gastritis; dry mouth; nausea; vomiting; abdominal pain or cramp; epigastric distress; diarrhea or bloody diarrhea; rectal bleeding; flatulence; enterocolitis; pseudomembranous colitis. GU: Interstitial nephritis (eg, oliguria, proteinuria, hematuria, hyaline casts, pyuria); nephropathy; increased BUN and creatinine. HEMATOLOGIC: Decreased hemoglobin, hematocrit, RBC, WBC, neutrophils, lymphocytes, platelets; increased lymphocytes, monocytes, basophils, eosinophils, and platelets. METABOLIC: Elevated serum alkaline phosphatase; hypernatremia; hypokalemia; albumin, total proteins and uric acid. OTHER: Hypersensitivity reactions (eg, urticaria, angioneurotic edema, laryngospasm, laryngeal edema, bronchospasm, hypotension, vascular collapse, death, maculopapular to exfoliative dermatitis, vesicular eruptions, erythema multiforme, serum sickness, skin rashes, prostration); vaginitis; hyperthermia.
Precautions
Pregnancy: Category B.
 Lactation: Small amount excreted in breast milk. 
May cause diarrhea, candidiasis, or allergic response in nursing infant. Hypersensitivity: Reactions range from mild to life threatening. Administer drug with caution to cephalosporin-sensitive patients because of possible crossreactivity. Pseudomembranous colitis: May occur because of overgrowth of clostridia. Renal impairment: Use drug with caution; dosage adjustment may be necessary. Streptococcal infections: Therapy must be minimum of 10 days. Superinfection: May result in bacterial or fungal overgrowth of nonsusceptible organisms.

PATIENT CARE CONSIDERATIONS

Administration/Storage
  • Administer without regard to food.
  • Administer at regular intervals around the clock.
  • Reconstituted oral suspension is stable for 14 days when refrigerated. Shake well before using.
Assessment/Interventions
  • Obtain patient history, including drug history and any known allergies.
  • Assess patient for infection at beginning and throughout therapy (eg, fever, WBC, appearance of wound).
  • Obtain specimens for culture and sensitivity before beginning therapy.
  • Observe for anaphylaxis. People with no history of hypersensitivity may develop allergic response.
  • Assess for signs of superinfection (eg, bacterial or fungal overgrowth of nonsusceptible organisms).
  • Monitor renal function, especially in patients with renal impairment.
  • If patient develops rash, pruritus, laryngeal edema, wheezing or evidence of hemolytic anemia (positive Coomb's test), or other signs of an allergic reaction, discontinue drug and notify health care provider.
  • If sudden elevation in temperature develops, notify health care provider; it may be drug fever.
  • Discontinue use of penicillin V if signs of hemolytic anemia develop (positive Coomb's test). 
  • Food: Best to take on empty stomach.
OVERDOSAGE: SIGNS & SYMPTOMS

Neuromuscular hyperexcitability, agitation, confusion, asterixis, hallucinations, stupor, coma, multifocal myoclonus, encephalopathy, hyperkalemia
Patient/Family Education
  • Instruct patient to complete entire course of therapy even if feeling better.
  • Advise patient to use calibrated measuring device for liquid preparation.
  • Instruct penicillin allergic patient to carry Medi-Alert necklace or bracelet.
  • Advise patient to use nonhormonal form of contraceptive during penicillin V therapy.
  • Inform patient of the signs of hypersensitivity (eg, skin rash, itching, hives, shortness of breath, wheezing) and other side effects, such as black tongue, sore throat, nausea, vomiting, severe diarrhea, fever, swollen joints. Instruct patient to notify health care provider if these symptoms occur.
  • Instruct patient to notify health care provider if there is no improvement in symptoms of infection.
  • Instruct patient to notify health care provider of signs of superinfection (eg, vaginitis, black “hairy” tongue).


الموضوعات السابقة 
http://werdoctors.blogspot.com/p/drug.html
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reference 
a to z drug facts 
bnf 61
clinicans handbook of prescription drug 

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