penicillin V (penicillin V potassium)

Drug Name

Generic Name : penicillin V (penicillin V potassium)

Brand Name: Novo-Pen VK (CAN), Veetids

Classification: Antibiotic, Penicillin (acid stable)

Pregnancy Category B 

Dosage & Route

Available forms : Tablets—250, 500 mg; powder for oral solution—125, 250 mg/5 mL

ADULTS AND PATIENTS > 12 YR
  • Fusospirochetal infections: 250–500 mg q 6–8 hr PO.
  • Streptococcal infections (including otitis media, URIs of mild to moderate severity, scarlet fever, erysipelas): 125–250 mg q 6–8 hr PO for 10 days. Or, 500 mg q 12 hr for 10 days.
  • Pneumococcal infections: 250–500 mg q 6 hr PO until afebrile for 48 hr.
  • Staphylococcal infections of skin and soft tissues: 250–500 mg q 6–8 hr PO.
  • Prophylaxis against bacterial endocarditis, dental or upper respiratory procedures: 2 g PO 30 min–1 hr before the procedure, then 500 mg q 6 hr for eight doses.
  • Alternate prophylaxis: 1 million units penicillin G IM mixed with 600,000 units procaine penicillin G 30 min–1 hr before the procedure, then 500 mg penicillin V PO q 6 hr for eight doses.
  • Lyme disease: 500 mg PO qid for 10–20 days.
  • Mild, uncomplicated cutaneous anthrax: 200–500 mg PO qid.
ADULTS AND PATIENTS > 9 YR
  • Anthrax prophylaxis: 7.5 mg/kg PO qid.
PEDIATRIC PATIENTS < 12 YR
  • 15–62.5 mg/kg/day PO given q 6–8 hr. Calculate doses according to weight.
  • Prophylaxis against bacterial endocarditis, dental or upper respiratory procedures:
    • < 60 lb: 1 g PO 30 min–1 hr before the procedure, then 250 mg q 6 hr for eight doses.
    • > 60 lb: 2 g PO 30 min–1 hr before the procedure, then 500 mg q 6 hr for eight doses.
  • Alternate prophylaxis for children: < 30 kg: 30,000 units penicillin G/kg IM mixed with 600,000 units procaine penicillin G 30 min–1 hr before the procedure and then 250 mg penicillin V PO q 6 hr for eight doses.
  • Sickle cell anemia as prophylaxis of S. pneumoniae septicemia: 125 mg PO bid.
  • Mild, uncomplicated cutaneous anthrax in children > 2 yr: 25–50 mg/kg daily in two or four divided doses.
PEDIATRIC PATIENTS < 9 YR
  • Anthrax prophylaxis: 50 mg/kg/day PO in four divided doses.
Therapeutic actions
  • Bactericidal: Inhibits cell wall synthesis of sensitive organisms, causing cell death.
Indications
  • Mild to moderately severe infections caused by sensitive organisms—streptococci, pneumococci, staphylococci, fusospirochetes
  • Prophylaxis against bacterial endocarditis in patients with valvular heart disease undergoing dental or upper respiratory tract surgery
  • Unlabeled uses: Prophylactic treatment of children with sickle cell anemia, mild to moderate anaerobic infections, Lyme disease, post-exposure anthrax prophylaxis
Adverse effects
  • CNS: Lethargy, hallucinations, seizures
  • GI: Glossitis, stomatitis, gastritis, sore mouth, furry tongue, black “hairy” tongue, nausea, vomiting, diarrhea, abdominal pain, bloody diarrhea, enterocolitis,pseudomembranous colitis, nonspecific hepatitis
  • GU: Nephritis—oliguria, proteinuria, hematuria, casts, azotemia, pyuria
  • Hematologic: Anemia, thrombocytopenia, leukopenia, neutropenia, prolonged bleeding time
  • Hypersensitivity reactions: Rash, fever, wheezing, anaphylaxis (sometimes fatal)
  • Other: Superinfections, sodium overload leading to CHF; potassium poisoning—hyperreflexia, coma, cardiac arrhythmias, cardiac arrest (potassium preparations)
Contraindications
  • Contraindicated with allergies to penicillins, cephalosporins, or other allergens.
  • Use cautiously with renal disorders, pregnancy, lactation (may cause diarrhea or candidiasis in the infant).
Nursing considerations
Assessment
  • History: Allergies to penicillins, cephalosporins, or other allergens; renal disorders; pregnancy; lactation
  • Physical: Culture infection; skin color, lesions; R, adventitious sounds; bowel sounds: CBC, LFTs, renal function tests, serum electrolytes, Hct, urinalysis
Interventions
  • Culture infection before beginning treatment; reculture if response is not as expected.
  • Continue therapy for at least 2 days after infection has disappeared, usually 7–10 days.
  • Do not administer oral drug with milk, fruit juices, or soft drinks; a full glass of water is preferred; this oral penicillin is less affected by food than other penicillins.
Teaching points
  • Avoid self-treating other infections with this antibiotic because it is specific for the infection being treated. Complete the full course of drug therapy.
  • You may experience these side effects: Nausea, vomiting, diarrhea, mouth sores.
  • Report difficulty breathing, rashes, severe diarrhea, mouth sores, unusual bleeding or bruising.