Penicillin

                                                                      Penicillin

By: Taylor DiDonato & Samantha Benjamin

                                                                    Background

•  A natural antibacterial agent obtained from the mold genus Penicillium
•  It was introduced to the military during World War ll
• Became widely used in 1945 and was labeled a “miracle” drug
•  “It was first introduced for the treatment of staphylococcal infections, but after a few years mutant strains of staphylococcus developed that were resistant to penicillins G and V because of the bacterial enzyme penicillinase, which destroys penicillin” (Kee, Hayes & McCuistion, 2012, p. 413)
• —Soldiers who would normally died from wound and respiratory infections were treated effectively with penicillin's.

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                                            Broad-Spectrum Penicillins (Aminopenicillins)

• —Used to treat both gram positive and gram negative bacteria
• —They are not as “broadly” effective against all microorganisms as they once were considered to be.
• —Examples: ampicillin (Omnipen) and amoxicillin (Amoxil)

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                           Penicillinase-Resistant Penicillins (Antistaphylococcal Penicillins)

• Used to treat penicillinase-producing S. aureus
• —Dicloxacillin (Dynapen) is an oral preparation of these antibiotics
• nafcillin (Unipen) and oxacillin (Prostaphin) are IM and IV preparations
• Not effective against gram-negative organisms and less effective then penicillin G against gram-positive organisms

 

—                            Extended Spectrum Penicillins (Antipseudomonal Penicillins)

• Broad-spectrum penicillins
• Effective against Pseudomonas aeruginosa, a gram-negative bacillus
• Useful against gram-negative organisms such as Proteus spp., Serratia spp., Klebsiella pneumonia, Enterobacter spp., and Acinetobacter spp.
• —Antipseudomanal penicillins are not penicillinase resistant
• —Less toxic then aminoglycosides but their pharmacologic actions are similar

 

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                                                     Beta-Lactamase inhibitors

• —Three beta-lactamase inhibitors: clavulanic acid, sulbactam , and tazobactam
• —These inhibitors are not given alone but in combination with penicillinase-sensitive penicillin such as amoxicillin, ampicillin, piperacillin, or ticarcillin

 

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                                                                  Adverse Effects

• Possible secondary infection due to disruption of normal body flora
• —Nausea
• —Vomiting
• —Diarrhea
• Severe allergic reactions: laryngeal edema, bronchoconstriction, stridor, and hypotension.

 

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                                                                Client Teaching

• —Teach clients to take the entire prescribed dosage.
• —Encourage clients to increase fluid intake; fluids aid in decreasing the body temperature and in excreting the drug
• —Medication should be take with food to avoid GI upset.
• —Patients should tell all providers if they have an allergy to penicillins.

 

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                                                                    Article

• Very Few Patients with Penicillin Allergy Histories Are Truly Allergic
• Approximately 8% of the US population claims to have an allergy to penicillin.
• The only true indicator to way to test for a penicillin allergy is by skin testing.
• —However many providers rarely order skin testing.

 

                                         

                                                                  References

Kee. , Hayes, , & McCuistion, (2012). Pharmacology: A nursing approach. (7th ed.). St. Louis, Missouri: Elsevier Saunders.

Amrol, D. (2013). Very few patients with penicillin allergy histories are truly allergic . New England Journal of Medicine, Retrieved from http://www.jwatch.org/na31567/2013/07/11/very-few-patients-with-penicillin-allergy-histories-are