Penicillins
Infectious Disease -ALL Agents (INDEX)
Penicillins
Ampicillin
| Use Indicated in the treatment of infections caused by susceptible strains of the designated organisms in the following conditions: Respiratory tract Infections caused by S. pneumoniae (formerly D. pneumoniae). Staphylococcus aureus (penicillinase and nonpenicillinase-producing), H. influenzae, and Group A beta-hemolytic Streptococci. Bacterial Meningitis caused by E. coli, Group B Streptococci, and other Gram-negative bacteria (Listeria monocytogenes, N. meningitidis). The addition of an aminoglycoside with ampicillin may increase its effectiveness against Gram-negative bacteria. Septicemia and Endocarditis caused by susceptible Gram-positive organisms including Streptococcus sp., penicillin G-susceptible staphylococci, and enterococci. Gram-negative sepsis caused by E. coli, Proteus mirabilis and Salmonella sp. respond to ampicillin. Endocarditis due to enterococcal strains usually respond to intravenous therapy. The addition of an aminoglycoside may enhance the effectiveness of ampicillin when treating streptoccoccal endocarditis. Urinary Tract Infections caused by sensitve strains of E. coli and Proteus mirabilis. Gastrointestinal Infections caused by Salmonella typhosa (typhoid fever), other Salmonella sp., and Shigella sp. (dysentery) usually respond to oral or intravenous therapy. Bacteriology studies to determine the causative organisms and their susceptibility to ampicillin should be performed. Therapy may be instituted prior to obtaining results of susceptibility testing. It is advisable to reserve the parenteral form of this drug for moderately severe and severe infections and for patients who are unable to take the oral forms. A change to oral ampicillin may be made as soon as appropriate. To reduce the development of drug-resistant bacteria and maintain the effectiveness of Ampicillin for Injection, USP and other antibacterial drugs, Ampicillin for Injection, USP should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria. When culture and susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy. In the absence of such data, local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy Dosing: Endocarditis prophylaxis: I.M., I.V.: Genitourinary and gastrointestinal tract (except esophageal) procedures: High-risk patients: 50 mg/kg (maximum: 2 g) within 30 minutes prior to procedure, followed by ampicillin 25 mg/kg (or amoxicillin 25 mg/kg orally) 6 hours later; must be used in combination with gentamicin. Moderate-risk patients: 50 mg/kg within 30 minutes prior to procedure Sepsis/meningitis: I.M., I.V.: 150-250 mg/kg/24 hours divided every 3-4 hours (range: 6-12 g/day) Endocarditis prophylaxis: I.M., I.V.: Genitourinary and gastrointestinal tract (except esophageal) procedures: -------------------------------- -------------------------------- |
Ampicillin/ sulbactam (unasyn ®)
| Treatment of susceptible bacterial infections involved with skin and skin structure, intra-abdominal infections, gynecological infections; spectrum is that of ampicillin plus organisms producing beta-lactamases such as S. aureus , H. influenzae , E. coli , Klebsiella , Acinetobacter , Enterobacter , and anaerobes ----------------------------- Dosing: Children >/= 1 year: I.V.: Mild-to-moderate infections: 100-150 mg ampicillin/kg/day (150-300 mg Unasyn®) divided every 6 hours; maximum: 8 g ampicillin/day (12 g Unasyn®) Severe infections: 200-400 mg ampicillin/kg/day divided every 6 hours; maximum: 8 g ampicillin/day (12 g Unasyn®) Adults: I.M., I.V.: 1-2 g ampicillin (1.5-3 g Unasyn®) every 6 hours; maximum: 8 g ampicillin/day (12 g Unasyn®) Renal Dosing: -------------------------------- |
Amoxicillin
| Dosing: Oral: Children </= 3 months: 20-30 mg/kg/day divided every 12 hours. Children: >3 months and <40 kg: Dosing range: 20-50 mg/kg/day in divided doses every 8-12 hours. Ear, nose, throat, genitourinary tract, or skin/skin structure infections: Mild to moderate: 25 mg/kg/day in divided doses every 12 hours or 20 mg/kg/day in divided doses every 8 hours Severe: 45 mg/kg/day in divided doses every 12 hours or 40 mg/kg/day in divided doses every 8 hours Acute otitis media due to highly-resistant strains of S. pneumoniae: Doses as high as 80-90 mg/kg/day divided every 12 hours have been used Lower respiratory tract infections: 45 mg/kg/day in divided doses every 12 hours or 40 mg/kg/day in divided doses every 8 hours Subacute bacterial endocarditis prophylaxis: 50 mg/kg 1 hour before procedure Ear, nose, throat, genitourinary tract or skin/skin structure infections: Endocarditis prophylaxis: 2 g 1 hour before procedure. Helicobacter pylori eradication: 1000 mg twice daily; requires combination therapy with at least one other antibiotic and an acid-suppressing agent (proton pump inhibitor or H2 blocker) -------------------------------- Powder for oral suspension, as trihydrate: 125 mg/5 mL (80 mL, 100 mL, 150 mL); 200 mg/5 mL (50 mL, 75 mL, 100 mL); 250 mg/5 mL (80 mL, 100 mL, 150 mL); 400 mg/5 mL (50 mL, 75 mL, 100 mL) Powder for oral suspension, as trihydrate [drops] (Amoxil®): 50 mg/mL (15 mL [DSC], 30 mL) [bubble gum flavor] |
Amoxicillin/ clavulanate (augmentin ®)
| Dosing: Children >/= 3 months and <40 kg: Otitis media: 90 mg/kg/day divided every 12 hours for 10 days Lower respiratory tract infections, severe infections, sinusitis: 45 mg/kg/day divided every 12 hours or 40 mg/kg/day divided every 8 hours. Less severe infections: 25 mg/kg/day divided every 12 hours or 20 mg/kg/day divided every 8 hours ----------------------------- CCommunity-acquired pneumonia: Extended release tablet: Two 1000 mg tablets every 12 hours for 7-10 days -------------------------------- Tablet: Tablet, chewable: Tablet, extended release (Augmentin XR™): Amoxicillin 1000 mg and clavulanic acid 62.5 mg |
Cloxacillin (tegopen ®)
| Microbiology Penicillinase-resistant penicillins exert a bactericidal action against penicillin-susceptible microorganisms during the state of active multiplication. All penicillins inhibit the biosynthesis of the bacterial cell wall. ---------------------------- Children (>20 kg) and Adults: 250-500 mg every 6 hours -------------------------------- Powder for oral suspension, as sodium: 125 mg/5 mL (100 mL, 200 mL) |
Dicloxacillin (dynapen ®)
| Microbiology Penicillinase-resistant penicillins exert a bactericidal action against penicillin-susceptible microorganisms during the state of active multiplication. All penicillins inhibit the biosynthesis of the bacterial cell wall. --------------------------- Dosing: Oral: Use in newborns not recommended Children <40 kg: 12.5-25 mg/kg/day divided every 6 hours; doses of 50-100 mg/kg/day in divided doses every 6 hours have been used for therapy of osteomyelitis Children >40 kg and Adults: 125-250 mg every 6 hours |
Nafcillin
| Microbiology Penicillinase-resistant penicillins exert a bactericidal action against penicillin-susceptible microorganisms during the state of active multiplication. All penicillins inhibit the biosynthesis of the bacterial cell wall. The drugs in this class are highly resistant to inactivation by staphylococcal penicillinase and are active against penicillinase producing strains of Staphylococcus aureus. The penicillinase-resistant penicillins are active in vitro against a variety of other bacteria --------------------------- I.V.: Adults: -------------------------------- |
Penicillin g
| Microbiology Penicillin G is bactericidal against penicillin-susceptible microorganisms during the stage of active multiplication. It acts by inhibiting biosynthesis of cell-wall mucopeptide. It is not active against the penicillinase-producing bacteria, which include many strains of staphylococci. Penicillin G is highly active in vitro against staphylococci (except penicillinase-producing strains), streptococci (groups A, B, C, G, H, L and M), pneumococci and Neisseria meningitidis. Other organisms susceptible in vitro to penicillin G are Neisseria gonorrhoeae, Corynebacterium diphtheriae, Bacillus anthracis, clostridia, Actinomyces species, Spirillum minus, Streptobacillus monillformis, Listeria monocytogenes, and leptospira; Treponema pallidum is extremely susceptible. Some species of gram-negative bacilli were previously considered susceptible to very high intravenous doses of penicillin G (up to 80 million units/day) including some strains of Escherichia coli, Proteus mirabilis, salmonella, shigella, Enterobacter aerogenes (formerly Aerobacter aerogenes) and Alcaligenes faecalis. Penicillin G is no longer considered a drug of choice for infections caused by these organisms --------------------------- Congenital syphilis: DDisseminated gonococcal infections or gonococcus ophthalmia (if organism proven sensitive): 100,000 units/kg/day in 2 equal doses (4 equal doses/day for infants >1 week) Gonococcal meningitis: 150,000 units/kg in 2 equal doses (4 doses/day for infants >1 week) Neurosyphilis: 18-24 million units/day in divided doses every 3-4 hours for 10-14 days -------------------------------- Infusion, as potassium [premixed iso-osmotic dextrose solution, frozen]: 1 million units (50 mL), 2 million units (50 mL), 3 million units (50 mL) Injection, powder for reconstitution, as potassium (Pfizerpen®): 5 million units, 20 million units Injection, powder for reconstitution, as sodium: 5 million units |
Penicillin vk
| Dosing: Adults (Usual): 250-500mg po q6h. --------------------------- Dosing: Oral: Systemic infections: Children <12 years: 25-50 mg/kg/day in divided doses every 6-8 hours; maximum dose: 3 g/day. Children >/= 12 years and Adults: 125-500 mg every 6-8 hours. Prophylaxis of pneumococcal infections: Prophylaxis of recurrent rheumatic fever: -------------------------------- Tablet: 250 mg, 500 mg |
Piperacillin (pipracil ®)
| Dosing: Infants and Children: I.M., I.V.: 200-300 mg/kg/day in divided doses every 4-6 hours Higher doses have been used in cystic fibrosis: 350-500 mg/kg/day in divided doses every 4-6 hours Adults: I.M., I.V.: Serious infections: 3-4 g/dose every 4-6 hours; maximum: 24 g/24 hours Uncomplicated gonorrhea: 2 g I.M. in a single dose accompanied by 1 g probenecid 30 minutes prior to injection |
Piperacillin/ tazobactam (zosyn ®)
| Microbiology Piperacillin sodium exerts bactericidal activity by inhibiting septum formation and cell wall synthesis of susceptible bacteria. In vitro, piperacillin is active against a variety of gram-positive and gram-negative aerobic and anaerobic bacteria. Tazobactam sodium has little clinically relevant in vitro activity against bacteria due to its reduced affinity to penicillin-binding proteins. It is, however, a β-lactamase inhibitor of the Richmond-Sykes class III (Bush class 2b & 2b') penicillinases and cephalosporinases. It varies in its ability to inhibit class II and IV (2a & 4) penicillinases. Tazobactam does not induce chromosomally-mediated β-lactamases at tazobactam concentrations achieved with the recommended dosage regimen. --------------------------- Nosocomial pneumonia: I.V.: Piperacillin/tazobactam 4/0.5 g every 6 hours for 7-14 days (when used empirically, combination with an aminoglycoside is recommended; consider discontinuation of aminoglycoside if P. aeruginosa is not isolated) Severe infections: I.V.: Piperacillin/tazobactam 4/0.5 g every 8 hours or 3/0.375 g every 6 hours for 7-10 days Moderate infections: I.M.: Piperacillin/tazobactam 2/0.25 g every 6-8 hours; treatment should be continued for >/= 7-10 days depending on severity of disease ( Note: I.M. route not FDA-approved) -------------------------------- Injection, powder for reconstitution: |
Ticarcillin
| Dosing: Adults: I.M., I.V.: 1 to 4 g every 4 to 6 hours, usual dose: 3 g I.V. every 4 to 6 hours -------------------------------- -------------------------------- |
Ticarcillin/ clavulanate (timentin ®)
| Dosing: I.V.: Children and Adults <60 kg: 200-300 mg of ticarcillin component/kg/day in divided doses every 4-6 hours Children >60 kg and Adults: 3.1 g (ticarcillin 3 g plus clavulanic acid 0.1 g) every 4-6 hours; maximum: 24 g/day Urinary tract infections: 3.1 g every 6-8 hours -------------------------------- Injection, powder for reconstitution: Ticarcillin disodium 3 g and clavulanate potassium 0.1 g (3.1 g, 31 g) |
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Reference(s)
National Institutes of Health, U.S. National Library of Medicine, DailyMed Database.
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