Penicillins include

Natural- Penicillin G, Penicillin V

Penicillase -Resistent-

Cloxacillin, Docloxacillin, Methicillin, Nafacillin, Oxacillin

Aminopenicillins-

Amoxicillin, Amoxicillin/Potassium Clavulanate, Ampicillin, Ampicillin/Sulbactum, Becampicillin

Extended spectrum-

Carbenicilin, Mezlocillin, Piperacillin.Tazobactam sodium, Ticarcillin, Ticarcillin/Potassium clavulanate Refer Penicillin V Potassium

 Interacting drugs- summary

 Penicillins +

Parentral + Aminoglycosides

certain penicillins inactivate certain aminoglycosides in vitro. Do not mix in the same IV in soln. Also oral neomycin reduce the serum conc. of oral penicillins

Patentral + Antocoagulants

  large doses of penicillin can increase bleeding risks of anticoagulants  by prolonging bleeding time. Conversely, naficillin associated with warfarin resistence

Penicillin Oral + Betablockers

ampicillin may reduce the bioavailability of atenolol. Beta blockers may potentiate anaphylactic reactions of penicillins

Contraceptives oral 

efficacy of oral contraceptives may be reduced . Although infreqently  reported the use of an additional form of contraception during penicillin therapy is advisable

Penicillins parntl + Heparin

an increased risk of bleeding may occur, possibly due to additive effects

Allopurinol + Ampicillin

 rate of ampicillin-induced skin rashes appears much higher with allopurinol coadministration than with either drug alone

Chloramphenicol + Penicillins

synergistic effects may develop, but antagonism has been reported in animal studies

Erythromycin + Penicillins

in vitro tests and clinical studies have demonstrated both antagonism and synergism with coadministration

Tetracycline + Penicillins

bacteriostatic action of tetracycline derivatives may impair the bactericidal effects of penicillins

Infections caused by susceptible strains of Shingella, Salmonella, Escherina, Coli etc.

Penicillins include

Natural- Penicillin G, Penicillin V

Penicillase -Resistent-

Cloxacillin, Docloxacillin, Methicillin, Nafacillin, Oxacillin

Aminopenicillins-

Amoxicillin, Amoxicillin/Potassium Clavulanate, Ampicillin, Ampicillin/Sulbactum, Becampicillin

Extended spectrum-

Carbenicilin, Mezlocillin, Piperacillin.Tazobactam sodium, Ticarcillin, Ticarcillin/Potassium clavulanate Refer Penicillin V Potassium

Rarely anaphylactic shock and pseudomembranous colitis.

Superinfection,GI upset,blood dyscrasis,urticaria(commoner in renal failure & disorders).

Diarrhoea.

Interferes with estimation of serum albumin, electrophoresis of urine for aminoacids and urinary glucose estimation.

Hypersens to penicillins.Infections due to penicillinase producing organisms.

Special precautions:

Infectious mononuecleosis,

reduced I.V. doses in patients with renal failure.

Indications:

Infections caused by susceptible strains of Shingella, salmonella, escherina coli, etc.

Dosage:

Adults- 1-12g daily in divide doses every 4 to 6 hrs

Children- 50-200mg/kg/day in divided doses every 6 hours. Use only freshly made solutions.

Administer IM/IV injections within 1 hour after preparation, since potency may decrease significantly after this period.

Direct IV administration: Administer slowly over 10 to 15 minutes. More rapid admin,\. may result in convulsive seizures.

Stability: Reconstituted oral solutions is stable for 7 days at room temp. (not exceeding 25C,77F).

Missed dose

1. If you miss a dose of this medicine take it as soon as possible. This will help to keep a constant amount of medicine in the blood or urine.

2. However, if it is almost time for your next dose skip the next dose and go back to your regular dosing schedule.

3. Do not double doses.

For Availability/supplies 

Non specific rashes-

Drugs causing adverse reactions-

1. Ampicillin.

2. Barbiturates

3. Allopurinol

4. Phenytoin

5. Methyldopa

1. Complete full course of therapy

2. Take on an empty stomach 1 hour before or 2 hours after meals. Absorption of Penicillin V, amoxycillin, becampicillin tablets and amoxycillin/potassium cluvinate is not significantly affected by food.

3. Take each oral dose with a full glass of water, not fruit juice or carbobanated beverage (cloxacillin, penicillin G)

4. Take at even intervals,preferably around the clock.

5. Notify physician, if skin rash, itching, hives, severe diarrhoea, shortness of breath, wheezing, black tongue, sore throat, nausea, vomiting, fever, swollen joints or unusual bleeding or bruising occurs

6. Discard any liquid forms of penicillin after 7 days if stored at room temperature or 14 days if it is refrigerated.

7.Allergies- tell your doctor if you have ever had any unusual or allergic reaction to penicillin or cephalosporins. Also tell your doctor if you are allergic to any other substances, such as foods, presevatives or dyes.

8.Pregnancy - penicillins have been widely used in pregnant woman and have not been shown to cause birth defects or other problems in animal studies.

9.Breast feeding- penicillins pass into breast milk. allergic reactions , diarrhea, fungus infectins and skin rash may occur in nursing babies

10. Children - Many penicillins have been used in children and in effective doses and are not expected to cause different side effects or problems in children than in adults.

11.Elderly- peniciilins have been used in elderly and have not been shown to cause different side effects or problems in older people than in younger adults.

12. Other medicines - Acetoaminophen or Amiodarone or Anabolic steroids or Androgens or Antithyroid agents or Carmustine or Chloroquine or Dantrolene or Daunorubicin or Disulfram or Divalproex or Estrogens or Etretinate or Gold salts or Hydroxychloroquine or Mercaptopurine or Methotrexate or Methyldopa or Naltrxone or Oral contraceptives or Other anti-infectives by mouth or injection or Phenothiothizines or Plicamycin or Valproic acid - these medicines may increase the chance of liver damage if taken with cloxacillin, dicloxacillin, flucoxacillin, mezlocillin, nafacillin, oxacilin, or pipercillin

 13. Other medical problems - Tell your doctor if you have any

other medical problems especially - Allergy such as asthma,eczema, hay fever etc.- patients with a history of general allergies may be more likely to have a severe reaction to penicilin

14.Missed dose - If you miss a dose of this medicine, take it as soon as possible. however, if it is almost time for the next dose, skip the missed dose. Do not double doses.

 15.Storage - Keep out of reach of children. Store away from heat or direct sunlight. Do not store the capsule in bathroom, near the kitchen sink, or in other damp places.

 16.Outdated medicines - Do not keep outdated medicine or medicine no longer needed. Be sure that any discarded medicine is out of reach of children.

Take on an empty stomach 1 hr before or 2 hr after meals