PENICILLIN V

PENICILLIN V
PENICILLIN V POTASSIUM
(pen-i-sill'in)
Apo-Pen-VK , Beepen VK, Betapen-VK, Ledercillin VK, Nadopen-V , Novopen-VK , Penicillin VK, Pen-V, Pen-Vee K, Robicillin VK, V-Cillin K, Veetids
Classifications: beta-lactam antibiotic; natural penicillin;
Therapeutic: antibiotic
; beta-lactam
Prototype: Penicillin G potassium
Pregnancy Category: B

Availability

250 mg, 500 mg tablets; 125 mg/5 mL, 250 mg/5 mL suspension

Action

Acid-stable analog of penicillin G with which it shares actions. It binds with the necessary penicillin-binding proteins (PBP) in cell wall of bacteria interfering with cell wall synthesis and resulting in cell lysis.

Therapeutic Effect

Penicillin V is bactericidal, and is inactivated by penicillinase. Less active than penicillin G against gonococci and other gram-negative microorganisms.

Uses

Mild to moderate infections caused by susceptible Streptococci, Pneumococci, and Staphylococci. Also Vincent's infection and as prophylaxis in rheumatic fever.

Contraindications

Hypersensitivity to any penicillin; lactation.

Cautious Use

History of or suspected allergy (hay fever, asthma, hives, eczema) reactions; hypersensitivity to cephalosporins, beta-lactamase inhibitors, or carbapenem; GI disease; cystic fibrosis; renal impairment, hepatic impairment; pregnancy (category B).

Route & Dosage

Mild to Moderate Infections
Adult: PO 125–500 mg q6h
Child (<12 y): PO 15–50 mg/kg/d in 3–6 divided doses

Endocarditis Prophylaxis
Adult: PO 2 g 30–60 min before procedure, then 500 mg q6h for 8 doses
Child (<30 kg): PO 1 g 30–60 min before procedure, then 250 mg q6h for 8 doses

Administration

Oral
  • Give after a meal rather than on an empty stomach; drug may be better absorbed and result in higher blood levels.
  • Do not coadminister with neomycin if both drugs are being used; malabsorption of penicillin V may result.
  • Shake well before pouring. Following reconstitution, oral solution is stable for 14 d under refrigeration.

Adverse Effects (≥1%)

Body as a Whole: Nausea, vomiting, diarrhea, epigastric distress. Hypersensitivity reactions (e.g., flushing, pruritus, urticaria or other skin eruptions, eosinophilia, anaphylaxis; hemolytic anemia, leukopenia, thrombocytopenia, neuropathy, superinfections).

Interactions

Drug: Probenecid decreases renal elimination; may decrease efficacy of oral contraceptives; colestipol decreases absorption. Food: Food increases breakdown in stomach.

Pharmacokinetics

Absorption: 60–73% absorbed from GI tract. Peak: 30–60 min. Duration: 6 h. Distribution: Highest levels in kidneys; crosses placenta; distributed into breast milk. Elimination: In urine. Half-Life: 30 min.

Nursing Implications

Note: See penicillin G potassium for numerous additional nursing implications.

Assessment & Drug Effects

  • Obtain careful history concerning hypersensitivity reactions to penicillins, cephalosporins, and other allergens before therapy begins.
  • Lab tests: Perform C&S tests prior to initiation and at regular intervals throughout therapy. Evaluate renal, hepatic, and hematologic systems at regular intervals in patients receiving prolonged therapy.

Patient & Family Education

  • Take penicillin V around the clock at specific intervals to maintain a constant blood level.
  • Do not miss any doses and continue taking medication until it is all gone unless otherwise directed by the physician.
  • Discontinue medication and promptly report to physician the onset of hypersensitivity reactions and superinfections (see Appendix F).
  • Use specially marked measuring device to ensure accurate doses of oral liquid preparation.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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