Penicillin V
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
- Recurrent Rheumatic Fever, prophylaxis
- 250mg BID[5]
Anthrax (Cutaneous)
- 25-50mg/kg/day divided BID-QID
- Max: 500mg per dose (Stevens, 2005)
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]
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
- 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
- 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
- Gerber, 2009; Shulman, 2012; WHO, 2004
- Shulman, 2012
- 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
- 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]
- Sanford Guide to Antimicrobial Therapy 2014
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