Part 1: Penicillin

• The penicillin group of antibiotics includes natural extracts from several strains of the Penicillium mold and a number of semisynthetic derivatives of many natural fermentation products first developed in the early 1940’s.

Major group of Penicillin drugs

• Penicillin G

  • First penicillin in extensive clinical use

  • Still considered a first line drug against most gram positive bacteria (except penicillinase-producing staphylococci) when given by IM injection

  • Virtually non toxic to human cells, thus can be given safely in large amounts

  • Widely distributed in the body, very low cost

  • Major disadvantages are irregular oral absorption, destruction by gastric acid, inactivation by penicillinase enzyme, and rather narrow antimicrobial spectrum of action.

Semisynthetic Derivatives:

• Penicillin V

  • Semisynthetic analogue of penicillin G with similar spectrum of activity

  • More completely absorbed orally than penicillin G and not destroyed by gastric acid, thus yielding three to five times higher blood levels

Part 2: Spectrum of Activity

Broad Spectrum Penicillin

• Broad Spectrum Penicillins - are used to treat both gram positive and negative bacteria.

• Effective against some gram negative bacteria:

  • Escherichia Coli

  • Haemophilus Influenzae

  • Shigella

  • Dysenteriae

  • Proteus Mirabilis

  • Salmonella

EXAMPLES

• Ampicillin Omnipen (Ampicin)

• Ampicillin + Sulbactam (Unasyn)

• Amoxicillin (Amoxil)

• Amoxicillin + Clavulanate (Augmentin)

• Bacampicillin (Spectrobid)

Penicillinase Resistant Penicillin

• Penicillinase Resistant Penicillins - (antistaphylococcal Penicillin) are used to treat penicillinase-producing staphylococcus aureus.

EXAMPLES

• Cloxacillin (Tegopen)

• Dicloxacillin Sodium (Dynapen)

• Methicillin (Staphcillin)

• Naficillin (Nafcin)

• Oxacillin Sodium (Prostaphlin)

Extended Spectrum Penicillin

• Antipseudomonal penicillin - are a group of broad spectrum penicillin.

• Effective against:

  • Pseudomonas Aeruginosa

  • Gram negative Bacillus

  • Proteus

  • Serratia

  • Klebsiella Pneumoniae

  • Enterobacter

  • Acinetobacter

EXAMPLES

• Carbenicillin (Geopen)

• Mezlocillin Sodium (Mezlin)

• Piperacillin-Tazobactam (Cypercil)

• Ticarcillin

• Ticarcillin + Clavulanate

Part 3: Benefits and Adverse Effects

Benefits:

1. Effective against a wide range of bacterial infections.

2. Treats various respiratory tract infections, such as pneumonia and bronchitis.

3. Effective against skin and soft tissue infections, including cellulitis.

4. Can be used to treat certain sexually transmitted infections, like syphilis and gonorrhea.

5. Helps prevent complications from certain infections, such as rheumatic fever.

Adverse Effects:

1. Allergic reactions, ranging from mild rashes to severe anaphylaxis.

2. Gastrointestinal disturbances, such as nausea, vomiting, and diarrhea.

3. Potential for antibiotic resistance development in bacteria.

4. Rarely, penicillin can cause serious side effects like kidney damage or blood disorders.

5. Some individuals may experience drug interactions or have contraindications to penicillin use.

It is important to note that this is a general overview, and individual responses to penicillin may vary. Always consult a healthcare professional for personalized advice and guidance.

Nursing Interventions

• Send a sample of material from the infected area to the laboratory for culture to determine antibiotic susceptibility before antibiotic therapy is started.

• Check for signs and symptoms of superinfection, especially for clients taking high doses of the antibiotic for a prolonged time. Signs and symptoms include stomatitis, genital discharge, and anal and genital itching.

• Examine clients for allergic reactions to the penicillin product, especially after the first and second doses. This may be a mild reaction such as a rash, or a severe reaction, such as respiratory distress or anaphylaxis.

• Have epinephrine available to counteract a severe allergic reaction.

• Do not mix aminoglycosides with a higher-dose or extended spectrum penicillin G because this combination may inactivate the aminoglycoside.

• Check clients for bleeding if high doses of penicillin are being given; a decrease in platelet aggregation may result.

• Food may decrease the absorption of many oral penicillin, so those penicillin should be taken with a full glass of water 1 hour before food intake or 2 hours after.

• Amoxicillin and Bacampicillin are penicillin that are unaffected by food.