Yes

Antibiotic, Penicillin

Dental: Antibiotic of first choice in treating common orofacial infections caused by aerobic gram-positive cocci and anaerobes. These orofacial infections include cellulitis, periapical abscess, periodontal abscess, acute suppurative pulpitis, oronasal fistula, pericoronitis, osteitis, osteomyelitis, postsurgical and post-traumatic infection. It is no longer recommended for dental procedure prophylaxis.

Medical: Treatment of infections caused by susceptible organisms involving the respiratory tract, otitis media, sinusitis, skin, and urinary tract; prophylaxis in rheumatic fever

B

Known hypersensitivity to penicillin or any component

Use with caution in patients with severe renal impairment (modify dosage), history of seizures, or hypersensitivity to cephalosporins

>10%: Gastrointestinal: Mild diarrhea, vomiting, nausea, oral candidiasis

<1%: Convulsions, fever, hemolytic anemia, positive Coombs' reaction, acute interstitial nephritis, hypersensitivity reactions, anaphylaxis

Symptoms of penicillin overdose include neuromuscular hypersensitivity (agitation, hallucinations, asterixis, encephalopathy, confusion, and seizures) and electrolyte imbalance with potassium or sodium salts, especially in renal failure

Hemodialysis may be helpful to aid in the removal of the drug from the blood, otherwise most treatment is supportive or symptom directed

Decreased effect: Tetracyclines may decrease penicillin effectiveness; decreased oral contraceptive effect is possible

Increased effect:

Probenecid may increase penicillin levels

Aminoglycosides may result in synergistic efficacy; heparin and parenteral penicillins may result in increased bleeding

Refrigerate suspension after reconstitution; discard after 14 days

Inhibits bacterial cell wall synthesis by binding to one or more of the penicillin binding proteins (PBPs); which in turn inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell walls, thus inhibiting cell wall biosynthesis. Bacteria eventually lyse due to ongoing activity of cell wall autolytic enzymes (autolysins and murein hydrolases) while cell wall assembly is arrested.

Absorption: Oral: 60% to 73% from GI tract

Distribution: Appears in breast milk

Plasma protein binding: 80%

Half-life: 0.5 hours; prolonged in patients with renal impairment

Time to peak serum concentration: Oral: Within 0.5-1 hour

Elimination: Penicillin V and its metabolites are excreted in urine mainly by tubular secretion

Oral:

Children <12 years: 25-50 mg/kg/day in divided doses every 6-8 hours; maximum dose: 3 g/day

Children greater than or equal to 12 years and Adults: 125-500 mg every 6-8 hours

Prophylaxis of pneumococcal infections:

Children <5 years: 125 mg twice daily

Children greater than or equal to 5 years and Adults: 250 mg twice daily

Prophylaxis of recurrent rheumatic fever:

Children <5 years: 125 mg twice daily

Children greater than or equal to 5 years and Adults: 250 mg twice daily

Dosing interval in renal impairment: Cl_cr <10 mL/minute: Administer 250 mg every 6 hours

Food: Decreases drug absorption rate; decreases drug serum concentration. Take on an empty stomach 1 hour before or 2 hours after meals.

Periodic renal and hematologic function tests during prolonged therapy; monitor for signs of anaphylaxis during first dose

False-positive or negative urinary glucose determination using Clinitest®; positive Coombs' [direct]; false-positive urinary and/or serum proteins

Penicillins reported to cause apprehension, illusions, hallucinations, depersonalization, agitation, insomnia, and encephalopathy

None reported

No information available to require special precautions

Prolonged use of penicillins may lead to development of oral candidiasis

Take at regular intervals around-the-clock, preferably on an empty stomach (1 hour before or 2 hours after meals) with 8 oz of water. Take entire prescription; do not skip doses or discontinue without consulting prescriber. Small frequent meals, frequent mouth care, sucking lozenges, or chewing gum may reduce nausea or dry mouth. Important to maintain good oral and vaginal hygiene to reduce incidence of opportunistic infection. If diabetic, drug may cause false tests with Clinitest® urine glucose monitoring; use of glucose oxidase methods (Clinistix®) or serum glucose monitoring is preferable. This drug may interfere with oral contraceptives; an alternate form of birth control should be used. Report persistent diarrhea, fever, chills, unhealed sores, bloody urine or stool, muscle pain, mouth sores, and difficulty breathing.

Administer around-the-clock rather than 4 times/day, 3 times/day, etc, (ie, 12-6-12-6, not 9-1-5-9) to promote less variation in peak and trough serum levels; dosage modification required in patients with renal insufficiency

250 mg = 400,000 units

Tablet: 125 mg, 250 mg, 500 mg

Dajani AS, Bisno AL, Chung KJ, et al, "Prevention of Rheumatic Fever. A Statement for Health Professionals by the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease of the Council on Cardiovascular Disease in the Young, The American Heart Association," Pediatr Infect Dis J, 1989, 8(5):263-6.

Wynn RL and Bergman SA, "Antibiotics and Their Use in the Treatment of Orofacial Infections, Part I and Part II," Gen Dent, 1994, 42(5):398-402, 498-502.