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.