Penicillin instructions for use injections doses. Special instructions for use

Penicillin is a narrow-spectrum antibiotic obtained from the mold fungus penicillium. This type of fungus, throughout the entire period of its life, is capable of synthesizing various varieties of penicillin that differ from each other chemical composition, as well as the effect they have on the human body.

Benzylpenicillin is often used in medicine to treat diseases of the upper and lower respiratory tract.

In addition, this drug has a huge historical meaning, since the first medical research, made after its discovery, proved that with the help of this medicine it is possible to completely cure people suffering from syphilis, staphylococcal and streptococcal infection.

Penicillin: active substance, release form and effect of treatment with the drug

The antibiotic penicillin is a drug whose chemical structure is based on a dipeptide formed from substances such as dimethylcysteine and acetylserine.

The mechanism of action of penicillins is to block the vitamin and amino acid metabolism of pathogenic microorganisms, as a result of which their reproduction completely stops and the cell wall is destroyed, which leads to their death.

Penicillin is excreted from the human body by the kidneys, as well as along with bile. Its content in urine is much higher than the concentration in the blood (almost 10 times).

In pharmacies, this drug is sold in powder form for the preparation of suspensions for injection. There are also penicillin tablets used to treat gonorrhea and other venereal diseases.

The classification of penicillins involves their division into natural and semi-synthetic. The second group is widely used in medicine and has a bactericidal as well as bacteriostatic effect, destroying the cell walls of pathogenic bacteria, preventing them from regenerating.

Antibiotics of the penicillin group do not have any effect on bacteria of the enteric-typhoid-dysenteric group, therefore it is not used for the treatment of diseases caused by these microorganisms. Also, Benzylpericillin, which is the most common drug belonging to the penicillin group, is ineffective in the treatment of pulmonary tuberculosis, whooping cough, plague, and cholera.

To achieve maximum effect from the drug, it is administered intramuscularly. This is explained by the fact that, in this way, the active substances of the drug are absorbed into the blood faster. Their highest concentration is observed within half an hour, maximum - 1 hour after the administration of penicillin to the patient.

It is worth noting that Penicillin tablets are used extremely rarely, which is explained by its poor absorption into the blood. Under the influence of gastric juice, the structure of the active components of the drug is destroyed, and this, in turn, leads to the fact that the results from such therapy have to wait a very long time.

Indications for the use of penicillin

The use of Penicillin must be justified. Otherwise, it may lead to adverse consequences.

Like any other antibiotic, this drug can cause severe allergic reactions, so using it for therapeutic purposes without being sure of its safety for the patient is strictly prohibited.

First of all, you need to undergo special allergy tests. They are performed in two ways.

Penicillin-based drugs are indicated for patients with various pathologies respiratory organs. They are often used:

Treatment with penicillin for the above diseases is highly effective, however, it is worth noting that you should not expect immediate results. As a rule, the course of therapy is 5-7 days, although if we're talking about about sexually transmitted diseases, this process may take longer.

Along with antibiotics, doctors always prescribe medications against dysbiosis. Be sure to follow all instructions and follow the instructions of your doctor, otherwise this may lead to the development of serious complications.

Features of the use of penicillin for the treatment of children and pregnant women

Penicillin group drugs are used with caution for the treatment of various diseases in women during pregnancy, as well as for the treatment of young children.

It is allowed to use such a medicine only if the child has reached one year of age.

At an earlier age, this medication can have an otogenic effect, which can lead to hearing problems in the baby.

It is important to know that the use of penicillin in the form of injections in small patients is permitted only in a hospital setting. Parents' decision to self-medicate may have serious consequences for a sick child, therefore the entire therapy process should be closely monitored by a qualified physician. At home, only oral use of the drug is allowed.

As for the use of Benzylpenicillin or Bicillin for women during pregnancy, its administration should be either intramuscular or intravenous. It is also allowed to use the medicine in the form of an ointment for external use. Taking pills for the treatment of diseases of the respiratory or genital tract is absolutely prohibited in order to avoid pathologies of intrauterine development of the fetus or adverse reactions in an infant.

Contraindications to the use of the drug

Penicillin is a very serious drug that has its own contraindications for use for therapeutic purposes. If precautions are neglected, this may lead to the development of serious side effects.

The use of this medicine is absolutely excluded:

During pregnancy.
In case of individual intolerance to the components of the drug.
If available allergic reactions(for urticaria, bronchial asthma, etc.).
In case of sudden reactions of the body to antibiotics of various nature.

Despite the fact that the use of this drug is undesirable during pregnancy and breastfeeding, it can still be used. However, this only happens if the benefit to the woman significantly outweighs the risk to the fetus.

Side effects of taking penicillin

When taking penicillin-based drugs, the patient must be aware of what this substance is and how the body may react to it.

In the first days of therapy, allergic reactions may occur, especially in women during pregnancy.

This is due to increased sensitivity of the body, which often develops as a result of earlier use of this drug or its analogues. Side effects from improper use of the drug can be as follows.

In addition to the above side effects, candidiasis of the oral cavity or vagina in women is often observed. In extremely rare cases, patients treated with Penicillin developed anaphylactic shock with fatal. If signs of such a condition appear in a patient, he must be given adrenaline intravenously.

Often, when treated with this drug, patients experience the development of dysbiosis. This anomaly is due to the fact that active ingredients drugs affect not only pathogenic microorganisms, but also on beneficial intestinal bacteria.

For this reason, when using penicillin-based therapy, it is important to take drops or capsules to promote recovery and maintenance. normal microflora intestines.

In addition to dysbiosis, patients may develop a fungal infection caused by Candida fungi. To prevent this from happening, the choice of antibiotic must be approached especially carefully. The patient is obliged to follow absolutely all the doctor’s recommendations without changing the dosage or number of uses of the drug.

Overdose of penicillin and its interaction with other drugs

Throughout the course of treatment, it is important to remember the dosage of this medication. It, as well as the entire treatment regimen, can only be prescribed by the attending physician, based on the patient’s complaints and the results of his tests.

If you take the drug in too high a concentration, it can lead to an overdose, manifested by nausea, vomiting, and severe diarrhea. However, don't panic: similar condition is not life-threatening for the patient.

When administering intravenous penicillin to patients suffering from renal failure, hyperkalemia may develop.

In addition, if the permissible dosage is exceeded for intramuscular or intravenous use the patient may experience epileptic seizures. However, it is worth noting that such anomalies occur only when more than 50 million units of the drug are administered in one approach. In this case, the patient is prescribed barbiturates or benzodiazepines.

This drug is not recommended for use together with Probenecid, since their incompatibility leads to a retention of the active substances of penicillin in the human body, which is why its elimination takes much longer than expected.

In addition, treatment with penicillin is contraindicated in the case of the use of such medications, How:

Tetracycline. In this case, the bactericidal effect of using Benzylpenicillin or Bicillin is significantly reduced.
Aminoglycosides, since they conflict with each other in the physicochemical aspect.
Thrombolytics.
Sulfonamides, which also significantly reduce the bactericidal effect of penicillins.
Cholestyramine reduces the bioavailability of penicillin group drugs.
Birth control pills.

Based on the foregoing, the patient must make an unambiguous conclusion that it is impossible to independently prescribe a course of treatment, during which various medications are combined: such actions can cause severe harm health.

The popularity of penicillins is due to their pronounced bactericidal effect, low toxicity and wide range of dosages. The disadvantages of this class of antibiotics include frequent allergies to penicillin and a high risk of cross-allergic reactions with others.

All representatives of this group can be divided into biosynthetic and semi-synthetic penicillins.

The first representative of natural antimicrobial drugs and the ancestor of the penicillin class is benzylpenicillin (penicillin).

The drug is completely unstable when taken orally and is completely destroyed in the gastrointestinal tract. Penicillin is for injection only. When administered intramuscularly, the drug is well absorbed and is capable of creating a significant therapeutic concentration within half an hour.

Other biosynthetic penicillins can be used for oral administration. Preparations of phenoxymethylpenicillin (Megacillin Oral ®, Penicillin v ®) and benzathine phenoxymethylpenicillin (Ospen) have good stability when taken orally, their bioavailability depends little on food intake.

Other long-acting natural penicillins (benzylpenicillin procaine and benzathine benzylpenicillin) are administered intramuscularly.

Semi-synthetic penicillins are also used orally (as a substitute for injectable penicillin):

extended spectrum (and Amoxicillin ®);
protected penicillins (/Clavulanate ®);
combination of two antibiotics (Ampicillin ® /).

Antistaphylococcal Oxacillin is also available in tablet form.

Inhibitor-protected antipseudomonas protected penicillins (Ticarcillin/clavulanate ®, Piperacillin/tazobactam ®) and antipseudomonas unprotected penicillins are used only intravenously.

Penicillin ® - what is it?

Benzylpenicillin ® is a biosynthetic antibiotic, the first natural antimicrobial drug.

Penicillin suppresses the synthesis of cell wall components in bacteria, disrupting membrane resistance, provoking the death of the pathogen. The mechanism of action of penicillins is bactericidal.

The drug has low toxicity and low cost, but this moment the level of acquired resistance in staphylo-, gono-, pneumococci and bacteroides is quite high, which limits its use in the treatment of diseases caused by these pathogens.

Allergy to penicillin is the most common side effect of its use. Therefore, before use, be sure to test for tolerance.

The antibiotic is active against non-penicillinase-forming strains of staphylococci, streptococci, treponemas, pathogen anthrax and diphtheria, some gram-negative pathogens (meningococci), etc. Rickettsia and most of gram pathogens, as well as strains that produce penicillinase, are resistant to penicillin.

Therapeutic concentration is achieved half an hour after intramuscular administration. The medicine is excreted from the body through urine and kidneys. It accumulates well in organs and tissues. However, it is not able to penetrate the prostate gland and does not overcome the blood-ophthalmic and unchanged blood-brain barriers.

Pharmacological group of penicillin ®

Beta-lactam antibiotics - penicillins.

Penicillin ® dosage forms

Benzylpenicillin is completely destroyed when exposed to an acidic environment, therefore it is not used orally and does not have a tablet form.

For injection it is produced in the form of benzylpenicillin:

sodium salt (penicillin g);
potassium salt;
procaine salt.

Procaine salt is characterized by the longest duration of therapeutic action. Sodium is the least toxic and rarely leads to local tissue irritation when administered; it is used in pediatric practice.

Penicillin g is produced in the form of bottles containing powder for the preparation of an injection solution of 500 thousand units and 1 million units.

Procaine salt is available in three hundred thousand, six hundred thousand and 1.2 million units.

Penicillin ® recipe in Latin

Example of a prescription for penicillin in Latin:

Rp.: Benzylpenicillini-natrii 1000000ED
D.t.d. №10 in flac.
S. IM 1,000,000 units 4 times a day in 2 ml of water for injection

Indications and contraindications for the use of penicillin ®

Prescribed for the treatment of bacterial infections associated with sensitive flora.

Local penicillin ® can be used to gargle and drop into the nose (for purulent, bacterial runny nose).

One of the methods of treating conjunctivitis in children is considered to be instillation of a weak solution of penicillin, however, when using this drug, you should consult your pediatrician; self-prescription is not recommended. This is due to the fact that an allergy to penicillin occurs even when prescribed locally and can manifest itself not only as burning of the mucous membrane, redness of the eye, but also angioedema or anaphylactic shock.

Systemic penicillin ® can be prescribed to eliminate infections: wound, urinary tract, skin and fatty acids. For therapy, osteomyelitis, septic endocarditis,. And also for pyemia, diphtheria (in combination with toxoid), actinomycosis, anthrax. Used for ENT pathologies and in ophthalmological practice.

The drug is contraindicated in patients who are allergic to penicillin or other beta-lactam agents, as there is a high risk of cross-hypersensitivity. It is also not prescribed to newborns from mothers with penicillin intolerance.

Intralumbar administration is not used to treat patients with epilepsy.

Wed can be prescribed from birth, but for children under two years of age it is prescribed only for health reasons, strictly as prescribed by a doctor.

Potassium salt is contraindicated in patients with arrhythmias and hyperkalemia.

Use with caution for women carrying a child or breastfeeding.

Dosage and instructions for use of penicillin ® sodium salt in ampoules (injections)

Penicillin g can be used intramuscularly, intravenously (boost or drip), and subcutaneously; endolumbar and intratracheal administration is also sometimes used.

Since allergies to penicillin are quite common, a sensitivity test to the drug must be performed before administration.

The standard daily dosage for adults of Penicillin g (intravenous administration) for moderately severe diseases is from one to two million units, for severe infections - up to 20 million units.

The dosage administered at a time is from 250 thousand to five hundred thousand units. Penicillin is administered four times a day.

In patients with gas gangrene, the daily dose ranges from 40 to 60 million units.

For babies up to one year old, from 50 to 100 thousand units/kg are administered per day. From a year – 50 thousand units/kg. In case of severe illness, the dosage can be increased to two hundred to three hundred thousand units/kg. The daily dose should be divided into four to six injections.

To comply with the penicillin dilution technique, the solution is prepared immediately before administration. When used intravenously, water for injection or 0.9% saline solution is used to dilute the powder. It is administered slowly over 5 to 10 minutes.

For drip administration, dilute with 0.9% saline and administer within an hour and a half.

Intravenous use can be alternated with IM (one or two times IV per day, the rest intramuscularly).

For intramuscular administration, water for injection, procaine solution, and 0.9% saline solution are used to dilute the powder.

Standard dose (per day) for moderate infections:

UAP (upper respiratory tract);
LDP (lower respiratory tract);
UVP (urinary);
Bile ducts (bile ducts);
Skin and fatty acids,

It ranges from 2.5 to 5 million units (for adults). The dose is administered 4 times.

The drug can also be used subcutaneously to clear up inflammatory infiltrates. Penicillin in a dose of 100 to 200 thousand is diluted with a 0.25-0.5% solution of procaine (1 milliliter).

In ophthalmology it is used in a dose of 20 to 100 thousand, diluted with saline or distilled water. Prescribe 1-2 drops four to six times a day. Before using the drug, you must consult your doctor.

Features of the use of penicillin ®

It is important to remember that all parenteral penicillin solutions must be used immediately. Since during storage the solution breaks down into metabolites.

With prolonged use of an antibiotic, the risk of fungal diseases of the skin and mucous membranes increases, therefore, for the purpose of prevention, B vitamins are prescribed, ascorbic acid, antifungal agents(Nystatin ®, less commonly Levorin ®).

It must be remembered that courses of treatment that are insufficient in duration, as well as low dosages, can cause the formation of antibiotic-resistant strains of bacteria.

During penicillin therapy, it is forbidden to drink alcohol, as they are strictly incompatible, juices, sweets, yoghurts and milk. It is also recommended to exclude baked goods and carbonated drinks.

Symptoms of a drug overdose include convulsions, meningeal symptoms, loss of consciousness, electrolyte disturbances, and arrhythmias.

Treatment of overdose is symptomatic. In severe cases, hemodialysis may be performed.

Penicillin can be used to treat women carrying a child, however, when prescribing the drug during lactation, it is recommended to stop breastfeeding. This is due to the ability of the antibiotic to penetrate into milk and cause sensitization, dyspeptic disorders and fungal infections in infants.

If there is no effect from monotherapy with penicillin for three to five days, it is necessary to switch to combination antibacterial therapy or change the drug.
Penicillin cannot be combined with Allopurinol ® and may result in a non-allergic rash.

Also, it is not prescribed with tetracycline, due to the antagonistic interaction of benzylpenicillin with bacteriostatic antimicrobial agents.

Penicillin interacts synergistically with bactericidal antibiotics.

It reduces the effectiveness of hormonal contraceptives, increasing the risk of unwanted pregnancy or bleeding (if they were used for therapeutic purposes).

It cannot be combined with anticoagulant drugs; this combination may cause bleeding. When prescribing an antibiotic to this category of patients, it is necessary to carefully and regularly monitor the prothrombin time.

The antibiotic does not affect the speed of mental and motor reactions, and also does not affect the ability to drive a car. However, it is important to consider the risk of side effects of the drug on the central nervous system and the cardiovascular system, as side effects can affect the ability to work with complex mechanisms.

Allergy to penicillin ® and other side effects from use

Undesirable effects from use may include an allergy to penicillin varying degrees gravity. Intolerance can manifest itself as urticaria, common and exfoliative dermatitis, arthralgia, bronchospachm, eosinophilia, angioedema, fever, erythema multiforme. Anaphylactic shock, thrombocytopenic purpura.

When using sodium salt (penicillin g), the pumping function of the heart may decrease.

Potassium is characterized by cardiac arrhythmias and hyperkalemia; in rare cases, cardiac arrest is possible.

Also possible: nephritis, meningeal symptoms, development of seizures.

A blood test may show a decrease in the number of leukocytes and neutrophils. Hemolytic anemia rarely develops.

Disorders from the gastrointestinal tract, phlebitis at the injection site may be observed (to prevent this, change the injection site every two days), etc.

During the treatment of syphilis, Jarisch-Herxheimer syndrome may develop, characterized by chills, fever, muscle and joint pain, serum sickness, tachycardia, a sharp decrease in blood pressure (up to collapse), abdominal pain and, rarely, heart failure.

Penicillin is the world's first antibiotic, which became a real salvation for millions of people. With its help, doctors were able to declare war on diseases that were considered fatal at that time: pneumonia, tuberculosis, sepsis. However, treatment of pathologies with the use of antibiotics should be carried out only after establishing accurate diagnosis and strictly as prescribed by the doctor.

The discovery of the antibacterial properties of penicillin occurred in 1928. The famous scientist Alexander Fleming, as a result of conducting a routine experiment with colonies of staphylococci, discovered stains of ordinary mold in some culture dishes.

As it turned out upon further study, there were no harmful bacteria in the cups with mold stains. Subsequently, it was from ordinary green mold that a molecule was derived that was capable of killing bacteria. This is how the first modern antibiotic, Penicillin, appeared.

Nowadays, penicillins are a whole group of antibiotics produced by certain types of mold (genus Penicillium).

They can be active against entire groups of gram-positive microorganisms, as well as some gram-negative ones: gonococci, streptococci, staphylococci, spirochetes, meningococci.

Penicillins belong to a large group of beta-lactam antibiotics, which contain a special beta-lactam ring molecule.

This is the largest family antibacterial drugs, which occupies a central place in the treatment of most infectious diseases. The antibacterial effect of beta-lactams lies in their ability to disrupt the synthesis of bacterial cell walls.

Antibiotics of the penicillin group are used in the treatment of a huge number of infectious diseases. They are prescribed when pathogenic microorganisms are sensitive to the drug for the treatment of the following pathologies:

many types of pneumonia;
sepsis;
septic endocarditis;
osteomyelitis;
angina;
bacterial pharyngitis;
meningitis;
infections of the genitourinary system, most of the gastrointestinal tract;
scarlet fever;
diphtheria;
anthrax;
gynecological diseases;
diseases of the ENT organs;
syphilis, gonorrhea and many others.

This type of antibiotic is also used in the treatment of wounds infected with bacteria. As a prevention of purulent complications, the drug is prescribed in the postoperative period.

The drug can be used in childhood for umbilical sepsis, pneumonia, otitis in newborns and infants, as well as young children. Penicillin is also effective for purulent pleurisy and meningitis.

Use of penicillin in medicine:

The use of penicillins to treat infections is not always possible. People who are highly sensitive to the drug are strictly prohibited from taking the drug.

The use of this antibiotic in patients suffering from asthma is also contraindicated. of various origins, hay fever with a history of

hives

or others

allergic reactions

on active substance.

Modern pharmacological companies produce penicillin preparations for injections or in tablet form. Products for intramuscular administration are produced in bottles (made of glass), sealed with rubber stoppers and metal caps on top. Before administration, the substrate is diluted with sodium chloride or water for injection.

Tablets are produced in cell packaging in dosages from 50 to 100 thousand units. It is also possible to produce ecmoline lozenges. The dosage in this case does not exceed 5 thousand units.

The mechanism of action of penicillin is the inhibition of enzymes involved in the formation of the cell membrane of microorganisms. The cell membrane protects bacteria from environmental influences; disruption of its synthesis leads to the death of pathogenic agents.

This is the bactericidal effect of the drug. It acts on some types of gram-positive bacteria (streptococci and staphylococci), as well as several types of gram-negative ones.

It is worth noting that penicillins can only act on multiplying bacteria. In inactive cells, membranes are not built, so they do not die due to enzyme inhibition.

The antibacterial effect of penicillin is achieved by intramuscular administration, oral administration, and local action. More often it is used for treatment injection form. When administered intramuscularly, the drug is quickly absorbed into the blood.

However, after 3-4 hours it completely disappears from the blood. Therefore, regular administration of drugs with at equal intervals from 4 times a day.

The drug can be administered intravenously, subcutaneously, or into the spinal canal. For treatment complex pneumonia, meningitis or syphilis, a special regimen is prescribed, which can only be prescribed by a doctor.

When taking penicillin in tablet form, the dosage must also be determined by your doctor. As a rule, when bacterial infections 250-500 mg is prescribed every 6-8 hours. If necessary, a single dose can be increased to 750 mg. The tablets should be taken half an hour before meals or 2 hours after. The duration of the course will be determined by the doctor.

Since penicillins are a natural drug, they have minimal toxicity among other groups of artificially bred antibiotics. However, allergic reactions are still possible.

They manifest themselves in the form of redness, rashes on the skin, and sometimes anaphylactic shock can occur. The occurrence of such pathologies is possible due to individual sensitivity to the drug or if the instructions are violated.

Other side effects may occur with the use of penicillins:

stomatitis;
rhinitis;
glossitis;
pharyngitis;
nausea;
diarrhea;
vomit;
pain in the injection area;
tissue necrosis at the injection site;
exacerbation of bronchial asthma;
fungal infections (candidiasis);
dysbacteriosis;
dermatitis.

Why an allergy to an antibiotic may occur, says Dr. Komarovsky:

When taking doses of penicillin that significantly exceed those prescribed by your doctor, an overdose may occur. First signs: nausea, vomiting, diarrhea. Such conditions are not dangerous for the patient’s life. Hyperkalemia may develop in patients with insufficient renal function.

Large doses of the drug administered intravenously or intraventricularly can provoke epileptic seizures. Such symptoms can only occur when a single dose of more than 50 million units is administered. To alleviate the patient's condition, benzodiazepines and barbiturates are prescribed.

Before using penicillin mandatory tests are carried out to determine sensitivity to the antibacterial drug. This drug should be prescribed with caution to patients with impaired renal function, as well as to patients diagnosed with heart failure.

The tablet form of penicillin should be taken with plenty of liquid. During treatment with penicillin antibiotics, it is important not to skip the recommended doses, since the effect of the drug may be weakened. If this happens, the missed dose should be taken as quickly as possible.

It happens that after 3-5 days after regular intake or the administration of the drug does not improve, then you should contact your doctor to adjust the course of treatment or dose of the drug. It is not recommended to interrupt the course of treatment without consulting a doctor.

Rules for the use of antibiotics:

When prescribing penicillin, attention should be paid to its interaction with other drugs used. This antibiotic should not be combined with the following medications:

Tetracycline reduces the effectiveness of penicillin antibiotics.
Aminoglycosides can conflict with penicillin in a chemical aspect.
Sulfonamides also reduce the bactericidal effect.
Thrombolytics.

Combining medications on your own is dangerous to health, so a course of antibiotics, taking into account all the details, should be prescribed by a doctor. If any drugs conflict with each other, an analogue may be prescribed.

Penicillin is considered one of the most inexpensive antibacterial drugs. The price of 50 bottles of powder to create a solution varies from 280 to 300 rubles. The cost of 250 mg tablets numbered 30 is just over 50 rubles.

As a replacement for regular penicillin, doctors can recommend the following drugs from the list: Cefazolin, Bicillin-1, 3 or 5, as well as Ampicillin, Amoxicillin, Azithromycin, Amoxiclav.

All these drugs have a broad bactericidal effect and are quite effective. However, to exclude allergic reactions, skin tests should be performed before use.

Penicillin analogues

Cheap analogues of penicillin include Ampicillin and Bicillin. Their cost in tablet form also does not exceed 50 rubles.

Synonyms for the drug are Procaine-benzylpenicillin, Benzylpenicillin sodium, potassium, novocaine salt.

Natural medicinal penicillins include:

Phenkoxymethylpenicillin;
Benzathine benzylpenicillin;
Benzylpenicillin salts (sodium, potassium, novocaine).

Before purchasing the antibiotic Penicillin, you must carefully read the instructions for use, methods of use and dosage, as well as other useful information for the drug Penicillin. On the website “Encyclopedia of Diseases” you will find all the necessary information: instructions for correct use, recommended dosage, contraindications, as well as reviews from patients who have already used this drug.

Penicillin is a waste product various types mold fungus Penicillium notatum, Penicilium chrysogenum, etc.

Several types of penicillin compounds, which are obtained in crystalline form, pass into the cultural liquid of these fungi.

Penicillin is an antibiotic whose chemical structure is based on a dipeptide formed from dimethylcysteine and acetylserine.

The mechanism of action of penicillin is associated with the suppression of amino acid and vitamin metabolism of microorganisms and disruption of the development of their cell wall.

Penicillin is excreted by the kidneys (about 50%); its significant concentrations are created in the urine, exceeding the concentrations in the blood by 5–10 times. Some penicillin is also excreted in the bile.

Penicillin is one of the main representatives of the group of antibiotics; the drug has a wide range of bacteriostatic and bactericidal effects (of the penicillin preparations, benzylpenicillin is the most active).

Streptococci, pneumococci, gonococci, meningococci, pathogens of tetanus, gas gangrene, anthrax, diphtheria, certain strains are especially sensitive to penicillin pathogenic staphylococci and protea.

Penicillin is ineffective against bacteria of the enteric-typhoid-dysenteric group, tuberculosis, whooping cough, Pseudomonas aeruginosa and Friedlander's bacilli, pathogens of brucellosis, tularemia, cholera, plague, as well as rickettsia, viruses, fungi and protozoa.

The most effective is intramuscular administration of penicillin preparations. With the intramuscular method of administration, penicillin is quickly absorbed into the blood (its maximum concentration in the blood is created after 30–60 minutes) and quickly passes into the muscles, lungs, wound exudate, and joint cavities.

The penetration of penicillin from the blood into the cerebrospinal fluid is insignificant, therefore, for meningitis and encephalitis, the combined use of penicillin is recommended - intramuscular and endolumbar.

Penicillin administered intramuscularly penetrates little into the abdominal and pleural cavities, which requires direct local exposure to penicillin.

Penicillin penetrates well through the placenta to the fetus.

The use of penicillin is indicated:

For sepsis (especially streptococcal);

In all sulfonamide-resistant cases of corresponding infections (pneumococcal, gonococcal, meningococcal infections, etc.);

For extensive and deeply localized infectious processes(osteomyelitis, severe phlegmon, gas gangrene);

After injuries involving and infection of large musculoskeletal masses;

In the postoperative period to prevent purulent complications;

For infected third and fourth degree burns;

For soft tissue injuries, chest injuries;

Purulent meningitis, brain abscesses, erysipelas, gonorrhea and its sulfonamide-resistant forms, syphilis, severe furunculosis, sycosis, and various inflammations of the eye and ear.

In the internal medicine clinic, Penicillin is used to treat lobar pneumonia(together with sulfonamide drugs), focal pneumonia, acute sepsis, cholecystitis and cholangitis, prolonged septic endocarditis, as well as for the prevention and treatment of rheumatism.

Penicillin is used in children: for umbilical sepsis, septicopyemia and septic-toxic diseases of newborns, pneumonia in newborns and infants and young children, otitis in infants and young children, septic form of scarlet fever, septic-toxic form of diphtheria (necessarily in combination with special serum), pleuropulmonary processes , not amenable to action sulfa drugs, purulent pleurisy and purulent meningitis, with gonorrhea.

The antimicrobial effect of Penicillin is achieved both through resorptive and local action.

Penicillin preparations can be administered intramuscularly, subcutaneously and intravenously, inside cavities, into the spinal canal, by inhalation, sublingually (under the tongue), orally; locally - in the form of eye and nasal drops, rinses, rinses.

When administered intramuscularly, penicillin is quickly absorbed into the blood, but after 3-4 hours penicillin almost completely disappears from it. For therapy to be effective, 1 ml of blood must contain 0.1–0.3 units of penicillin, therefore, to maintain a therapeutic concentration of the drug in the blood, it should be administered every 3–4 hours.

The use of Penicillin for the treatment of gonorrhea, syphilis, pneumonia, and cerebrospinal meningitis is carried out according to special instructions.

Treatment with benzylpenicillins, bicillins and other penicillin-containing drugs may be accompanied by side effects, most often of an allergic nature.

The occurrence of allergic reactions to penicillin drugs is usually associated with sensitization of the body to them as a result of previous use of these drugs, as well as as a result of prolonged exposure to them: professional sensitization of nurses and people working in the production of antibiotics.

Allergic reactions are less common upon first contact with penicillin. They occur mainly in people suffering from allergic diseases (urticaria, bronchial asthma).

Allergic reactions to penicillin on the skin are expressed in erythema, limited or widespread rashes, urticaria and urticarial rashes, macular, vesicular, pustular rashes, and sometimes life-threatening exfoliative dermatitis.

Numerous cases of contact dermatitis have been reported (medical personnel medical institutions). Contact dermatitis and reactions from the skin and mucous membranes are observed both with general exposure and with local use of Penicillin in the form of ointments, lotions, drops for the nose and eyes.

On the part of the respiratory system, rhinitis, pharyngitis, laryngopharyngitis, asthmatic bronchitis, bronchial asthma.

From the outside gastrointestinal tract allergic reactions are expressed in stomatitis, nausea, vomiting, diarrhea.

In some cases, the distinction between toxic and allergic genesis side effects difficult. The allergic origin of these phenomena is indicated by their combination with skin rashes; under the influence of penicillin, the development of agranulocytosis is also possible.

If allergic reactions occur from the skin, respiratory tract, gastrointestinal tract, treatment with penicillin should be stopped or its dose reduced, and the patient should be prescribed Diphenhydramine, Pipolfen, Suprastin, calcium chloride, vitamin B1.

It should be remembered about the possibility of sensitization of the body even in the prenatal period when treating pregnant women with penicillin preparations.

The occurrence of anaphylactic shock when using Penicillin is a very serious complication that can develop regardless of the dose and route of administration of penicillin and, in severe cases, result in death within a short time (5–30–60 minutes), therefore, before injecting penicillin and its preparations, anamnestic records should be collected data on the use of penicillin drugs in the past and reactions to it.

If anaphylactic shock occurs, 0.2–0.3 ml of 0.1% Adrenaline should be immediately (!) administered intravenously (mixed with the patient’s blood). Injections are repeated until the patient recovers from a serious condition.

At the same time, 0.2–0.3 ml of a 0.1% adrenaline solution is injected into the penicillin injection site. Effective drip administration of norepinephrine (1.0 ml of 0.1% solution in 500 ml of 5% glucose solution) for 3 hours.

Prednisolone - 0.02 g intramuscularly or intravenously, atropine sulfate 0.1% solution - 0.5–0.8 ml subcutaneously, lobeline hydrochloride 1% solution - 0.5–1.0 ml intravenously or subcutaneously.

Instead of adrenaline, you can administer 1 ml of 5% Ephedrine, as well as Eufillin - 5-10 ml of a 2.4% solution with 20-40 ml of a 40% glucose solution intravenously, Diphenhydramine - 5% solution intramuscularly, 1 ml (or Pipolfen), chloride calcium - 10% solution, 10 ml intravenously.

Oxygen is under pressure.

Hydrocortisone - during shock and mainly for prevention late complications in a single dose of 0.05–0.07 g.

Intramuscular administration of a neurolytic mixture is also used: 2 ml of a 2.5% solution of Aminazin, 2 ml of 2% solutions of Promedol and Diphenhydramine and a 5% solution of vitamin B1 (using an anti-shock solution and vasopressor substances).

When recovering from a state of shock, patients require hospitalization and clinical observation, as late complications are possible.

When treated with Penicillin, as with other antibiotics, the occurrence of pathological conditions may be associated with the development of dysbiosis.

The basis of dysbiosis is that penicillin, like other antibiotics, has an antimicrobial effect in the body not only on pathogenic microorganisms, but also on opportunistic and non-pathogenic microbes, as a result of which the natural antagonism of microbial associations for the body is disrupted, non-pathogenic microorganisms can acquire pathogenic nature- so-called superinfections occur.

The body is affected by penicillin-resistant microbes (Proteus, Enterococcus, Pseudomonas aeruginosa, penicillin-resistant strains of staphylococci).

There are complications associated with the activation and proliferation of yeast-like (especially in weakened patients) saprophytic fungi present in the microbial flora of the mucous membranes of the oral cavity and genitals, trachea, and intestines.

Penicillin, by suppressing fungal antagonist bacteria, can create favorable conditions for the development of yeast-like flora. Clinically, candidiasis can occur in acute and chronic form With pathological manifestations from the skin and mucous membranes (thrush of the mouth, genitals, etc.); from the outside internal organs(visceral candidiasis) in the form of damage to the lungs and upper respiratory tract; in the form of septic syndrome.

The appearance of candidiasis can be prevented by a rational choice of antibiotic, its correct dosage, regimen of use, the use of appropriate vaccines and serums, and establishing the sensitivity of the patient’s body to the antibiotic (by conducting special tests).

For the treatment of candidiasis in such cases, iodine preparations (1-3-5% solutions of potassium iodide) are prescribed in combination with intravenous administration of a 40% solution of hexamethylenetetramine, gentian violet 0.05-0.10 g 2-3 times a day, nicotinamide and others preparations of B vitamins.

For the prevention and treatment of candidiasis, special antifungal antibiotics are used, taken orally - Nystatin in tablets of 500,000 units, 6-10 tablets per day and Levorin 500,000 units 2-3 times a day in tablets or capsules, as well as ointments with nystatin sodium and levorin.

The use of penicillin is contraindicated in the presence of hypersensitivity to penicillin, bronchial asthma, urticaria, hay fever and other allergic diseases, or in patients with hypersensitivity to antibiotics, sulfonamides and other drugs.

It is possible for the body to become sensitized to penicillin during fetal development when pregnant women are treated with penicillin antibiotics.

Drinking alcohol during treatment with penicillin is strictly contraindicated.

Before using penicillin and its preparations, it is necessary to conduct sensitivity tests to them.

V-Penicillin Slovakpharma

Amoxisar

Amoxicillin

Amoxicillin capsules 0.25 g

Amoxicillin DS

Amoxicillin sodium sterile

Amoxicillin Sandoz

Amoxicillin-ratiopharm

Amoxicillin-ratiopharm 250 TC)

Amoxicillin trihydrate

Amoxicillin trihydrate (Purimox)

Ampicillin

Ampicillin AMP-KID

Ampicillin AMP-Forte

Ampicillin Innotec

Ampicillin sodium

Ampicillin sodium sterile

Ampicillin-AKOS

Ampicillin-Ferein

Ampicillin sodium salt

Ampicillin sodium salt, sterile

Ampicillin sodium salt-Vial

Ampicillin trihydrate

Ampicillin trihydrate capsules 0.25 g

Ampicillin trihydrate tablets 0.25 g

Benzathine benzylpenicillin sterile

Benzathinebenzylpenicillin sterile

Benzylpenicillin

Benzylpenicillin sodium salt

Benzylpenicillin sodium salt crystalline

Benzylpenicillin sodium salt, sterile

Benzylpenicillin sodium salt-Vial

Benzylpenicillin novocaine salt

Bicillin

Vepicombin

Gonoform

Grunamox

Danemox

Carbenicillin disodium salt 1 g

Cloxacillin

Cloxacillin sodium

Megacillin yelled

Oxacillin

Oxacillin sodium salt

Oxacillin sodium salt, sterile

Oxacillin sodium salt tablets

Ospamox

Penicillin G sodium salt

Penicillin G sodium salt, sterile

Pentrexil

Pipracil

Picillin

Procaine penicillin G 3 mega

Procaine-Benzylpenicillin

Procainebenzylpenicillin sterile

Prostaflin

Puricillin

Retarpen 1.2

Retarpen 2.4

Standacillin

Phenoxymethylpenicillin

Phenoxymethylpenicillin (for suspension)

Phenoxymethylpenicillin tablets

Flemoxin Solutab

Flucloxacillin

Hiconcil

Extensillin

I. Penicillin preparations obtained by biological synthesis (biosynthetic penicillins):

I.1. For parenteral administration (destroyed in acidic environment stomach):

Short acting:

benzylpenicillin (sodium salt),

benzylpenicillin (potassium salt);

Long-lasting:

benzylpenicillin (novocaine salt),

Bicillin-1,

Bicillin-5.

I.2. For enteral administration (acid-resistant):

phenoxymethylpenicillin (penicillin V).

II. Semi-synthetic penicillins

II.1. For parenteral and enteral administration (acid-resistant):

Penicillinase-resistant:

oxacillin (sodium salt),

nafcillin;

Broad spectrum of action:

ampicillin,

amoxicillin.

II.2. For parenteral administration (destroyed in the acidic environment of the stomach)

Broad spectrum of action, including Pseudomonas aeruginosa:

carbenicillin (disodium salt),

ticarcillin,

azlocillin.

II.3. For enteral administration (acid-resistant):

carbenicillin (indanyl sodium),

carfecillin.

According to the classification of penicillins given by I.B. Mikhailov (2001), penicillins can be divided into 6 groups:

1. Natural penicillins (benzylpenicillins, bicillins, phenoxymethylpenicillin).

2. Isoxazolepenicillins (oxacillin, cloxacillin, flucloxacillin).

3. Amidinopenicillins (amdinocillin, pivamdinocillin, bacamdinocillin, acidocillin).

4. Aminopenicillins (ampicillin, amoxicillin, talampicillin, bacampicillin, pivampicillin).

5. Carboxypenicillins (carbenicillin, carfecillin, carindacillin, ticarcillin).

6. Ureidopenicillins (azlocillin, mezlocillin, piperacillin).

The source of production, spectrum of action, as well as combination with beta-lactamases were taken into account when creating the classification given in the Federal Guide (formulary system), issue VIII.

1. Natural:

benzylpenicillin (penicillin G),

phenoxymethylpenicillin (penicillin V),

benzathine benzylpenicillin,

benzylpenicillin procaine,

benzathine phenoxymethylpenicillin.

2. Antistaphylococcal:

oxacillin.

3. Extended spectrum (aminopenicillins):

ampicillin,

amoxicillin.

4. Active against Pseudomonas aeruginosa:

Carboxypenicillins:

ticarcillin.

Ureidopenicillins:

azlocillin,

piperacillin.

5. Combined with beta-lactamase inhibitors (inhibitor-protected):

amoxicillin/clavulanate,

ampicillin/sulbactam,

ticarcillin/clavulanate.

Natural (natural) penicillins are narrow-spectrum antibiotics that affect gram-positive bacteria and cocci. Biosynthetic penicillins are obtained from the culture medium on which certain strains of molds (Penicillium) are grown. There are several varieties of natural penicillins, one of the most active and persistent of them is benzylpenicillin. In medical practice, benzylpenicillin is used in the form of various salts - sodium, potassium and novocaine.

All natural penicillins have similar antimicrobial activity. Natural penicillins are destroyed by beta-lactamases, and therefore are ineffective for the treatment of staphylococcal infections, because in most cases, staphylococci produce beta-lactamases. They are effective primarily against gram-positive microorganisms (including Streptococcus spp., including Streptococcus pneumoniae, Enterococcus spp.), Bacillus spp., Listeria monocytogenes, Erysipelothrix rhusiopathiae, gram-negative cocci (Neisseria meningitidis, Neisseria gonorrhoeae), some anaerobes (Peptostreptococcus spp., Fusobacterium spp.), spirochetes (Treponema spp., Borrelia spp., Leptospira spp.). Gram-negative organisms are usually resistant, with the exception of Haemophilus ducreyi and Pasteurella multocida. Penicillins are ineffective against viruses (causative agents of influenza, polio, smallpox, etc.), mycobacterium tuberculosis, the causative agent of amebiasis, rickettsia, and fungi.

Benzylpenicillin is active mainly against gram-positive cocci. Spectra antibacterial action benzylpenicillin and phenoxymethylpenicillin are almost identical. However, benzylpenicillin is 5–10 times more active than phenoxymethylpenicillin against susceptible Neisseria spp. and some anaerobes. Phenoxymethylpenicillin is prescribed for infections medium degree gravity. The activity of penicillin preparations is determined biologically by their antibacterial effect on a specific strain Staphylococcus aureus. The activity of 0.5988 mcg of chemically pure crystalline sodium salt of benzylpenicillin is taken as a unit of action (1 unit).

Significant disadvantages of benzylpenicillin are its instability to beta-lactamases (with enzymatic cleavage of the beta-lactam ring by beta-lactamases (penicillinases) to form penicillanic acid, the antibiotic loses its antimicrobial activity), insignificant absorption in the stomach (requires injection routes of administration) and relatively low activity against most gram-negative microorganisms.

IN normal conditions benzylpenicillin preparations penetrate poorly into the cerebrospinal fluid, but in case of inflammation meninges permeability through the BBB increases.

Benzylpenicillin, used in the form of highly soluble sodium and potassium salts, acts for a short time - 3–4 hours, because is quickly eliminated from the body and requires frequent injections. In this regard, poorly soluble salts of benzylpenicillin (including novocaine salt) and benzathine benzylpenicillin were proposed for use in medical practice.

Prolonged forms of gasylpenicillin, or depot-disylline: bicillin-1 (benzatina gasylpenicillin), as well as combined drugs based on them-bicillin-3 (benzatin gasylpenicillin sodium + gasylpenicillin novocaine salt), bicillin-5 (gasoline-gasoline gasolineylpiline + gasylpenicillin novocaine salt ), are suspensions that can only be administered intramuscularly. They are slowly absorbed from the injection site, creating a depot in muscle tissue. This allows you to maintain the concentration of the antibiotic in the blood for a significant time and thus reduce the frequency of drug administration.

All benzylpenicillin salts are used parenterally, because they are destroyed in the acidic environment of the stomach. Of the natural penicillins, only phenoxymethylpenicillin (penicillin V) has acid-stable properties, although to a weak extent. Phenoxymethylpenicillin differs in chemical structure from benzylpenicillin in the presence of a phenoxymethyl group in the molecule instead of a benzyl group.

Benzylpenicillin is used for infections caused by streptococci, including Streptococcus pneumoniae ( community-acquired pneumonia, meningitis), Streptococcus pyogenes (streptococcal tonsillitis, impetigo, erysipelas, scarlet fever, endocarditis), with meningococcal infections. Benzylpenicillin is the antibiotic of choice in the treatment of diphtheria, gas gangrene, leptospirosis, and Lyme disease.

Bicillins are indicated, first of all, when it is necessary to maintain effective concentrations in the body for a long time. They are used for syphilis and other diseases caused by Treponema pallidum (yaws), streptococcal infections (excluding infections caused by group B streptococci) - acute tonsillitis, scarlet fever, wound infections, erysipelas, rheumatism, leishmaniasis.

In 1957, 6-aminopenicillanic acid was isolated from natural penicillins and the development of semisynthetic drugs began on its basis.

6-Aminopenicillanic acid is the basis of the molecule of all penicillins (“penicillin core”) - a complex heterocyclic compound consisting of two rings: thiazolidine and beta-lactam. A side radical is associated with the beta-lactam ring, which determines the essential pharmacological properties of the resulting drug molecule. In natural penicillins, the structure of the radical depends on the composition of the medium in which Penicillium spp grow.

Semi-synthetic penicillins are obtained by chemical modification by adding various radicals to the 6-aminopenicillanic acid molecule. In this way, penicillins were obtained with certain properties:

Penicillinase (beta-lactamase) resistant;

Acid-resistant, effective when administered orally;

Having a wide spectrum of action.

Isoxazolepenicillins (isoxazolyl penicillins, penicillinase-stable, antistaphylococcal penicillins). Most staphylococci produce a specific enzyme beta-lactamase (penicillinase) and are resistant to benzylpenicillin (80–90% of strains are penicillinase-forming Staphylococcus aureus).

The main antistaphylococcal drug is oxacillin. The group of penicillinase-resistant drugs also includes cloxacillin, flucloxacillin, methicillin, nafcillin and dicloxacillin, which due to high toxicity and/or low effectiveness have not found clinical use.

The spectrum of antibacterial action of oxacillin is similar to that of benzylpenicillin, but due to the resistance of oxacillin to penicillinase, it is active against penicillinase-forming staphylococci that are resistant to benzylpenicillin and phenoxymethylpenicillin, as well as resistant to other antibiotics.

In terms of activity against gram-positive cocci (including staphylococci that do not produce beta-lactamase), isoxazolepenicillins, incl. oxacillin are significantly inferior to natural penicillins, therefore, for diseases caused by microorganisms sensitive to benzylpenicillin, they are less effective compared to the latter. Oxacillin does not show activity against gram-negative bacteria (except Neisseria spp.) and anaerobes. In this regard, drugs of this group are indicated only in cases where it is known that the infection is caused by penicillinase-forming strains of staphylococci.

The main pharmacokinetic differences between isoxazolepenicillins and benzylpenicillin:

Rapid, but not complete (30–50%) absorption from the gastrointestinal tract. These antibiotics can be used both parenterally (i.m., i.v.) and orally, but 1–1.5 hours before meals, because they have low resistance to hydrochloric acid;

High degree of binding to plasma albumin (90–95%) and the inability to remove isoxazolepenicillins from the body during hemodialysis;

Not only renal, but also hepatic excretion, no need to adjust the dosage regimen for mild renal failure.

The main clinical value of oxacillin is the treatment of staphylococcal infections caused by penicillin-resistant strains of Staphylococcus aureus (except infections caused by methicillin-resistant Staphylococcus aureus, MRSA). It should be taken into account that strains of Staphylococcus aureus resistant to oxacillin and methicillin are common in hospitals (methicillin, the first penicillinase-resistant penicillin, has been discontinued). Nosocomial and community-acquired strains of Staphylococcus aureus resistant to oxacillin/methicillin are usually multidrug-resistant - they are resistant to all other beta-lactams, and often also to macrolides, aminoglycosides, and fluoroquinolones. The drugs of choice for MRSA infections are vancomycin or linezolid.

Nafcillin is slightly more active than oxacillin and other penicillinase-resistant penicillins (but less active than benzylpenicillin). Nafcillin penetrates the BBB (its concentration in the cerebrospinal fluid is sufficient for the treatment of staphylococcal meningitis), is excreted primarily in bile (the maximum concentration in bile is much higher than the serum concentration), and to a lesser extent by the kidneys. Can be used orally and parenterally.

Amidinopenicillins are penicillins with a narrow spectrum of action, but with predominant activity against gram-negative enterobacteria. Amidinopenicillin preparations (amdinocillin, pivamdinocillin, bacamdinocillin, acidocillin) are not registered in Russia.

In accordance with the classification presented by D.A. Kharkevich, semisynthetic antibiotics wide range actions are divided into the following groups:

I. Drugs that do not affect Pseudomonas aeruginosa:

Aminopenicillins: ampicillin, amoxicillin.

II. Drugs active against Pseudomonas aeruginosa:

Carboxypenicillins: carbenicillin, ticarcillin, carfecillin;

Ureidopenicillins: piperacillin, azlocillin, mezlocillin.

Aminopenicillins are broad-spectrum antibiotics. All of them are destroyed by beta-lactamases of both gram-positive and gram-negative bacteria.

Amoxicillin and ampicillin are widely used in medical practice. Ampicillin is the founder of the aminopenicillin group. In relation to gram-positive bacteria, ampicillin, like all semisynthetic penicillins, is inferior in activity to benzylpenicillin, but superior to oxacillin.

Ampicillin and amoxicillin have similar action spectra. Compared to natural penicillins, the antimicrobial spectrum of ampicillin and amoxicillin extends to sensitive strains of enterobacteria, Escherichia coli, Proteus mirabilis, Salmonella spp., Shigella spp., Haemophilus influenzae; They act better than natural penicillins on Listeria monocytogenes and sensitive enterococci.

Of all oral beta-lactams, amoxicillin has the greatest activity against Streptococcus pneumoniae, which is resistant to natural penicillins.

Ampicillin is not effective against penicillinase-forming strains of Staphylococcus spp., all strains of Pseudomonas aeruginosa, most strains of Enterobacter spp., Proteus vulgaris (indole-positive).

Combination drugs are available, for example Ampiox (ampicillin + oxacillin). The combination of ampicillin or benzylpenicillin with oxacillin is rational, because the spectrum of action with this combination becomes wider.

The difference between amoxicillin (which is one of the leading oral antibiotics) and ampicillin is its pharmacokinetic profile: when taken orally, amoxicillin is absorbed more quickly and well in the intestine (75–90%) than ampicillin (35–50%), bioavailability does not depend on food intake . Amoxicillin penetrates better into some tissues, incl. into the bronchopulmonary system, where its concentrations are 2 times higher than those in the blood.

The most significant differences in the pharmacokinetic parameters of aminopenicillins from benzylpenicillin:

Possibility of administration internally;

Insignificant binding to plasma proteins - 80% of aminopenicillins remain in the blood in free form - and good penetration into tissues and body fluids (with meningitis, concentrations in the cerebrospinal fluid can be 70–95% of concentrations in the blood);

Multiplicity of appointment combination drugs- 2–3 times a day.

The main indications for prescribing aminopenicillins are infections of the upper respiratory tract and ENT organs, kidney and urinary tract infections, gastrointestinal infections, eradication of Helicobacter pylori (amoxicillin), meningitis.

A feature of the undesirable effect of aminopenicillins is the development of an “ampicillin” rash, which is a maculopapular rash of a non-allergic nature, which quickly disappears when the drug is discontinued.

One of the contraindications to the administration of aminopenicillins is infectious mononucleosis.

Store in a cool, dry place, protected from light. The expiration date is individual and is indicated in the instructions for each drug of the penicillin group.

We want to convert Special attention that the description of the antibiotic Penicillin is presented for informational purposes only! To obtain more accurate and detailed information about the drug Penicillin, we ask you to refer exclusively to the manufacturer’s annotation! Do not self-medicate under any circumstances! You should definitely consult a doctor before starting to use the drug!

Penicillin is a narrow-spectrum antibiotic obtained from the mold fungus penicillium. Throughout the entire period of its life, this type of fungus is capable of synthesizing various varieties of penicillin, differing from each other in chemical composition, as well as the effect they have on the human body.

Benzylpenicillin is often used in medicine to treat diseases of the upper and lower respiratory tract.

In addition, this drug is of great historical significance, since the first medical studies done after its discovery proved that with the help of this medicine it is possible to completely cure people suffering from syphilis, staphylococcal and streptococcal infections.

Penicillin: active substance, release form and effect of treatment with the drug

The antibiotic penicillin is a drug whose chemical structure is based on a dipeptide formed from substances such as dimethylcysteine and acetylserine.

Many of our readers actively use

Monastic gathering of Father George

It consists of 16 medicinal plants, which have extremely high efficiency in the treatment of chronic COUGH, bronchitis and cough caused by smoking.

Penicillin is excreted from the human body by the kidneys, as well as along with bile. Its content in urine is much higher than the concentration in the blood (almost 10 times).

In pharmacies, this drug is sold in powder form for the preparation of suspensions for injection. There are also penicillin tablets used to treat gonorrhea and other sexually transmitted diseases.

Feedback from our reader - Natalia Anisimova

The use of Penicillin must be justified. Otherwise, it may lead to adverse consequences.

Like any other antibiotic, this drug can cause severe allergic reactions, so using it for therapeutic purposes without being sure of its safety for the patient is strictly prohibited.

First of all, you need to undergo special allergy tests. They are performed in two ways.

The first method of performing allergy tests involves the direct participation of the patient. On back side Several shallow scratches are made with the brush using a special pen (as when taking a blood test). The laboratory assistant drops a small amount of the drug into the resulting wounds.

The result of such a test can be seen in about half an hour, although sometimes you have to wait a little longer. If redness or swelling appears on the treated surface, the patient feels a burning sensation and severe itching, then this is evidence of an allergy to penicillin. In this case, the doctor will have to look for a replacement drug with which it will be possible to cure this or that disease without risk or danger to the patient’s health.

Option two involves conducting a special analysis venous blood. This does not require the patient’s personal presence, since the results of such an allergy test are prepared within 5-7 days and involve the use of certain reagents.

Penicillin-based drugs are indicated for patients with various pathologies of the respiratory system. They are often used:

for pneumonia (focal or lobar);
for the treatment of pleural empyema;
for the purpose of relieving septic endocarditis occurring in catarrhal and subacute forms;
to combat sepsis (blood poisoning);
with pyaemia and septicemia;
for therapeutic purposes for osteomyelitis occurring in acute or chronic form;
for the treatment of meningitis of varying severity;
for the purpose of relieving infectious diseases of the gallbladder and urinary tract;
for the treatment of pustules on the skin, mucous membranes or soft tissues;
with sore throat (especially purulent);
to relieve symptoms of scarlet fever;
for medicinal purposes in erysipelas;
with anthrax;
for the treatment of ENT diseases of varying nature and severity;
with actinomycosis;
for the purpose of treating diphtheria;
at gynecological diseases having a purulent or inflammatory nature;
for therapeutic purposes for eye diseases;
for the treatment of sexually transmitted diseases, in particular gonorrhea, syphilis;
with blenorrhea;
for the treatment of bronchitis;
for the treatment of pneumonia.

Treatment with penicillin for the above diseases is highly effective, however, it is worth noting that you should not expect immediate results. As a rule, the course of therapy is 5-7 days, although if we are talking about sexually transmitted diseases, this process may take longer.

Features of the use of penicillin for the treatment of children and pregnant women

Penicillin group drugs are used with caution for the treatment of various diseases in women during pregnancy, as well as for the treatment of young children.

It is allowed to use such a medicine only if the child has reached one year of age.

At an earlier age, this medication can have an otogenic effect, which can lead to hearing problems in the baby.

It is important to know that the use of penicillin in the form of injections in small patients is permitted only in a hospital setting. A parent's decision to self-medicate can have serious consequences for a sick child, so the entire therapy process should be closely monitored by a qualified physician. At home, only oral use of the drug is allowed.

Contraindications to the use of the drug

Penicillin is a very serious drug that has its own contraindications for use for therapeutic purposes. If precautions are neglected, this may lead to the development of serious side effects.

The use of this medicine is absolutely excluded:

During pregnancy.
In case of individual intolerance to the components of the drug.
In case of allergic reactions (urticaria, bronchial asthma, etc.).
In case of sudden reactions of the body to antibiotics of various nature.

Side effects of taking penicillin

When taking penicillin-based drugs, the patient must be aware of what this substance is and how the body may react to it.

In the first days of therapy, allergic reactions may occur, especially in women during pregnancy.

This is due to increased sensitivity of the body, which often develops as a result of earlier use of this drug or its analogues. Side effects from improper use of the drug can be as follows.

From the digestive system:
- diarrhea;
- vomit;
- nausea.
From the side of the central nervous system:
- neurotoxic reactions;
- the appearance of symptoms of meningism;
- coma;
- convulsions.
Allergic reactions to the drug:
- development of urticaria;
- increased body temperature;
- the appearance of rashes on the surface of the skin, as well as on the mucous membranes of the mouth, nose, etc.;
- eosinophilia;
- swelling of the limbs or face.

In addition to the above side effects, candidiasis of the oral cavity or vagina in women is often observed. In extremely rare cases, patients treated with Penicillin have developed anaphylactic shock with a fatal outcome. If signs of such a condition appear in a patient, he must be given adrenaline intravenously.

Often, when treated with this drug, patients experience the development of dysbiosis. This anomaly is due to the fact that the active components of the drug affect not only pathogenic microorganisms, but also beneficial intestinal bacteria.

For this reason, when carrying out penicillin-based therapy, it is important to take drops or capsules that help restore and maintain normal intestinal microflora.

Overdose of penicillin and its interaction with other drugs

If you take the drug in too high a concentration, it can lead to an overdose, manifested by nausea, vomiting, and severe diarrhea. However, do not panic: this condition is not life-threatening for the patient.

When penicillin is administered intravenously, hyperkalemia may develop in patients suffering from renal failure.

In addition, if the permissible dosage is exceeded when using the drug intramuscularly or intravenously, the patient may experience epileptic seizures. However, it is worth noting that such anomalies occur only when more than 50 million units of the drug are administered in one approach. In this case, the patient is prescribed barbiturates or benzodiazepines.

In addition, treatment with penicillin is contraindicated in the case of the use of medications such as:

Tetracycline. In this case, the bactericidal effect of using Benzylpenicillin or Bicillin is significantly reduced.
Aminoglycosides, since they conflict with each other in the physicochemical aspect.
Thrombolytics.
Sulfonamides, which also significantly reduce the bactericidal effect of penicillins.
Cholestyramine reduces the bioavailability of penicillin group drugs.
Birth control pills.

Based on the above, the patient must make an unambiguous conclusion that it is impossible to independently prescribe a course of treatment during which various medications are combined: such actions can cause severe harm to health.

If a particular penicillin-based medicine is contraindicated for use, the doctor can prescribe its analogue, which will be absolutely safe for the patient’s health. Doctors often recommend the use of such medications, How:

Benzylpenicillin sodium salt has a bactericidal effect.
Benzylpenicillin potassium salt.
Phenoxymethylpenicillin.
Bicillin-1, 3 and 5.
Ampicillin.
Eficillin.
Methicillin sodium salt.

Before using any of the above drugs, allergy tests must be performed. This will help avoid the development of serious complications and allergic reactions from using the antibiotic for therapeutic purposes.

nervousness, sleep and appetite disturbances...
frequent colds, problems with the bronchi and lungs….
headaches…
bad breath, plaque on teeth and tongue...
change in body weight...
diarrhea, constipation and stomach pain...
exacerbation of chronic diseases...

Bondarenko Tatyana

Expert of the OPnevmonii.ru project

At the beginning of the last century, many diseases were incurable or difficult to treat. People died from simple infections, sepsis and pneumonia.
Wikimedia Commons/Carlos de Paz ()
A real revolution in medicine occurred in 1928, when penicillin was discovered. In all of human history, there has never been a drug that has saved as many lives as this antibiotic.

Over the course of decades, it has cured millions of people and remains one of the most effective medications to this day. What is penicillin? And to whom does humanity owe its appearance?

What is penicillin?

Penicillin is part of the group of biosynthetic antibiotics and has a bactericidal effect. Unlike many other antiseptic drugs, it is safe for humans, since the fungal cells that make up it are fundamentally different from the outer shells of human cells.

The action of the drug is based on inhibition of the vital activity of pathogenic bacteria. It blocks the substance peptidoglycan they produce, thereby preventing the formation of new cells and destroying existing ones.

What is penicillin for?

Penicillin is capable of destroying gram-positive and gram-negative bacteria, anaerobic bacilli, gonococci and actinomycetes.

Since its discovery, it has become the first effective drug against pneumonia, skin infections and biliary tract, anthrax, ENT diseases, syphilis and gonorrhea.

Nowadays, many bacteria have managed to adapt to it, mutated and formed new species, but the antibiotic is still successfully used in surgery to treat acute purulent diseases and remains last hope for patients with meningitis and furunculosis.

What does penicillin consist of?

The main component of penicillin is the mold fungus penicillium, which forms on products and leads to their spoilage. It can usually be seen as a blue or greenish colored mold. The healing effect of the fungus has been known for a long time. Back in the 19th century, Arab horse breeders removed mold from damp saddles and smeared it on the wounds on the backs of horses.

In 1897, the French doctor Ernest Duchesne was the first to test the effects of mold on guinea pigs and managed to cure them of typhus. The scientist presented the results of his discovery at the Pasteur Institute in Paris, but his research did not receive the approval of medical luminaries.

Who discovered penicillin?

The discoverer of penicillin was the British bacteriologist Alexander Fleming, who managed to completely accidentally isolate the drug from a strain of fungi.

For a long time after the discovery, other scientists tried to improve the quality of the drug, but only 10 years later, bacteriologist Howard Flory and chemist Ernst Chain were able to produce a truly pure form of the antibiotic. In 1945, Fleming, Florey and Chain received the Nobel Prize for their achievements.

History of the discovery of penicillin

The history of the discovery of the drug is quite interesting, since the appearance of the antibiotic was serendipity. During those years, Fleming lived in Scotland and was engaged in research in the field of bacterial medicine. He was quite messy, so he didn’t always clean up the test tubes after tests. One day, a scientist left home for a long time, leaving Petri dishes with staphylococcus colonies dirty.

When Fleming returned, he found that mold was growing on them, and in some places there were areas without bacteria. Based on this, the scientist came to the conclusion that mold is capable of producing substances that kill staphylococci.

Wikimedia Commons / Steve Jurvetson () A bacteriologist isolated penicillin from fungi, but underestimated his discovery, considering the manufacture of the medicine too difficult. The work was completed for him by Flory and Chain, who managed to come up with methods for purifying the drug and launching it into mass production.

Despite its impressive age, penicillin continues to be one of the most commonly used antibiotics for the treatment of sore throat. Even a large number of analogues and antibiotics of other families, during the isolation and development of which pharmacists tried to circumvent the shortcomings of penicillin, were unable to displace it from medical practice. Penicillin for sore throat is widely used in both adults and children, although its use is associated with some difficulties and limitations.

On a note

Other names for penicillin (mostly used in scientific community) - benzylpenicillin and penicillin G. In this case, compounds such as benzathine benzylpenicillin or procaine benzylpenicillin, although they are its analogs and belong to the penicillin family, differ from the original substance in some properties.

Three-dimensional model of the molecule of the first antibiotic - penicillin

The effectiveness of penicillin for angina

Penicillin is a bactericidal antibiotic. When it enters the source of infection, it interferes with the synthesis and restoration of bacterial cell walls, which leads to their rapid death. Due to this, by the way, penicillin acts very quickly, and patients notice signs of improvement after taking it within the first day after the first injection.

Initially, penicillin effectively destroyed both pathogens of sore throat - streptococcus and staphylococcus, and therefore, immediately after its introduction into the arsenal of doctors, it was used to effectively treat sore throat in all situations.

Today, in most cases of the disease, staphylococcus is resistant to penicillin, since over several decades of use of this antibiotic it has managed to develop resistance to it.

At the same time, staphylococcal tonsillitis occurs on average in 10% of cases, and in another 10% the disease is caused by a mixed staphylococcal and streptococcal infection. This means that penicillin for sore throat may be ineffective in about one case out of five. In other situations, this also works quite effectively for adults.

The causative agents of bacterial sore throat are streptococcus and staphylococcus

On a note

In addition, strains of staphylococci sensitive to penicillin are sometimes found today. However, this happens less and less every year. If the doctor knows that a sore throat is caused by a staphylococcal or mixed staphylococcal-streptococcal infection, in order to prescribe penicillin he needs to obtain data on the sensitivity of the pathogen to antibiotics. Only after such an examination will he be able to say whether penicillin will help with sore throat.

Penicillin is also effective in cases of atypical gonococcal tonsillitis. This is partly why the diagnosis itself is made less often than the disease actually happens: sore throat caused by gonococcus is very similar to streptococcal and even if the doctor makes a mistake in diagnosis, it is successfully cured using this remedy.

In some countries today there is an increase in the number of cases in which the use of penicillin is unsuccessful even against streptococcal infections. For example, in some cities in Germany, in 28% of cases the use of penicillin does not produce results, and some authors indicate even 35-38%, that is, in every third case, after several days of unsuccessful use, penicillin has to be replaced with other antibiotics.

Gonococcus is the causative agent of gonorrhea; if it gets into the throat it can cause gonococcal sore throat.

More often, this is not due to the development of resistance in the streptococcus itself (although this is being noted more and more often), but due to the fact that, along with streptococcus, other bacteria are present in the deep tissues of the tonsils that do not cause inflammation, but produce enzymes that break down penicillin. Thus, these bacteria (usually non-pathogenic staphylococci or Haemophilus influenzae) protect the causative agent of sore throat from the antibiotic.

Interestingly, the more often inflammation of the tonsils occurs (even not associated with a sore throat), the more copathogen bacteria are present in them and the greater the likelihood that penicillin will not work specifically for sore throat.

How to determine whether an infectious agent is resistant to penicillin or not?

To identify resistance, a smear of mucus from the tonsils is taken from the patient and a bacteriological examination is carried out. Based on the results of the analysis, it becomes known which bacterium caused the sore throat, which antibiotics it is sensitive to, and which it is resistant to. Such an examination takes several days, and when severe course illness, when there may not be time, the doctor usually prescribes antibiotics that are likely to act even on resistant bacteria - a mixture of amoxicillin with clavulanic acid, antibiotics of the macrolide family, and others. This allows you to quickly begin treatment and in most cases ensures recovery.

A smear from the tonsils will help to accurately determine the causative agent of a sore throat, but during its analysis, in most cases, the disease can already be cured

Advantages and disadvantages of penicillin

Penicillin has several advantages, thanks to which it successfully competes with many more modern antibiotics. Among these positive qualities:

On the other hand, it is precisely the shortcomings of penicillin that require pharmacists to constantly strive to develop more advanced analogues. Here are the main disadvantages of penicillin:

A specific property of penicillin is its rapid elimination from the body. It acts for 3-4 hours after administration, after which most of the substance is eliminated from the body and the injection must be repeated. This rate of elimination has both positive and negative sides. The disadvantage is the need to frequently repeat injections (and therefore the need for hospital treatment), the advantage is the ability to quickly stop therapy if side effects occur.

Other penicillin preparations, in particular its procaine and benzathine salts, on the contrary, are characterized by a very long presence in the body, due to which they are used to prevent complications of angina.

Penicillin preparations

There are a large number of penicillin preparations on the market today. At the same time, in different means The antibiotic is found in two different chemical forms:

Benzylpenicillin potassium salt;
Sodium salt of benzylpenicillin.

Penicillin is sold in this form in pharmacies.

Procaine and benzathine salts of benzylpenicillin are also actively used, but they have different pharmacokinetics and are used as part of bicillins - long-acting drugs for the prevention of complications of angina.

Here are just the main penicillin preparations:

Bicillins - Bicillin-1, Bicillin-3, Bicillin-5, Retarpen, Extensillin
Capicillin;
Angincillin;
Novopen;
Cracillin;
Christacillin;
Pradupen;
Pharmacillin;
Lanacillin;
Falapen...

Procaine salts of penicillin are used in bicillins

…and others. Basically, all of them are imported products, some are no longer produced today. In our country, benzine penicillin salts, packaged in special vials, are usually used for injection.

Rules of application

To treat angina, penicillin preparations are administered intramuscularly into the gluteal muscle, sometimes intravenously (only sodium salt). The doses of these drugs for the treatment of sore throat are the same.

For angina, it is prescribed in the amount of 3-6 million units per day (about 1.8-3.6 g) for 4-6 injections. The specific amount is prescribed by the doctor depending on the severity of the disease.

Injections are the main method of introducing penicillin into the body.

Penicillin for angina for children is prescribed in quantities of 50-150 thousand units per kg of body weight per day. The total dose is divided into 4-6 injections. As a rule, for children aged from six months to 2 years, a single dose is 240-250 mg, from 2 to 6 years - 300-600 mg, 7-12 years - 500-900 mg.

During treatment, it is very important to maintain the frequency of injections without missing injections. The general course of using penicillin for angina should be approximately 10-12 days, but not less than a week. If complications are suspected, the doctor may extend treatment to 21 days, or prescribe a course of bicillin prophylaxis.

Premature cessation of treatment or irregular injections are fraught with the development of complications of angina.

What to do if penicillin against a sore throat does not help?

If penicillin is clearly ineffective in specific case it is replaced by antibiotics of other groups - macrolides, cephalosporins, and sometimes lincosamides. Sometimes products based on penicillin antibiotics with auxiliary components - clavulanic acid or sulbactam - can be effective. In this case, obvious signs of the action of penicillin should appear within a few hours, most likely after 1-2 days of treatment. Practice shows that if effective treatment begins during the first 9 days of illness, angina is extremely rarely complicated. Accordingly, when timely application It is quite acceptable to see a doctor to try to inject penicillin, and if it does not help, prescribe another drug.

Safety, side effects and contraindications

The main side effects after using penicillin are allergies, and in some cases they can be very severe. They usually manifest themselves with the following set of symptoms:

Skin rash all over the body;
Bronchospasm;
Temperature increase;
Eosinophilia.

Model of an eosinophil, a type of blood cell that helps the body fight bacteria

Also, when treated with penicillin, violations are possible. heart rate(potassium salt can lead to cardiac arrest, sodium salt can lead to a decrease in the pumping function of the myocardium). Potassium salts also sometimes cause hyperkalemia.

If any significant side effects develop, penicillin is usually replaced with antibiotics from other groups.

During pregnancy, penicillin can be prescribed by a doctor if further use of the antibiotic will proceed under his supervision. The doctor must very correctly assess the balance between the risk of the drug affecting the fetus and the danger of the sore throat itself. Penicillin crosses the placental barrier, but negative influence does not affect the fetus. In the first months of pregnancy, the use of true penicillin can increase the contractile activity of the uterus and cause the risk of spontaneous abortion. Other penicillins - amosicillin, ampicillin - are safer.

As a rule, when using penicillin, it is not necessary to transfer the child to formula milk

Breastfeeding is usually not interrupted while penicillin is used during lactation. Penicillin penetrates into breast milk, and with it into the child’s digestive tract, but since it is not absorbed from the gastrointestinal tract, it does not have a systemic effect on the baby’s body. In cases of dysbacteriosis, the doctor can either replace the penicillin itself or prescribe the child means to restore the intestinal microflora.

In children themselves, penicillin for sore throat can be used from birth, but only under the strict supervision of a doctor. In this case, it does not enter the stomach and intestines and, therefore, rarely causes allergies and dysbiosis.

Rules of choice: when to prescribe penicillin and when to prescribe other antibiotics

Josamycin-based tablets - an alternative to penicillin injections

Today, all over the world, injections of penicillin are increasingly being replaced by taking tablets and other oral medications based on its analogues - amoxicillin, ampicillin - as well as antibiotics of other groups - cefadroxil, erythromycin, josamycin. This is done primarily for sore throat in children, so as not to traumatize their psyche with painful injections and not cause fear of the doctor. Also, the doctor may prefer other antibiotics for a sore throat to penicillin for the following reasons:

Conversely, doctors prefer to prescribe penicillin itself for angina in the following situations:

Conclusions:

Penicillin is often used for angina and, when prescribed by a doctor, in most cases can cure the disease;
Penicillin can only be used by injection. You can’t “drink” it;
Dosages and duration of treatment with penicillin are prescribed only by a doctor, taking into account the severity of the disease and the patient’s condition.

Penicillin instructions for use injections doses. Special instructions for use

Penicillin: active substance, release form and effect of treatment with the drug

Indications for the use of penicillin

Features of the use of penicillin for the treatment of children and pregnant women

Contraindications to the use of the drug

Side effects of taking penicillin

Overdose of penicillin and its interaction with other drugs

Penicillin ® - what is it?

Pharmacological group of penicillin ®

Penicillin ® dosage forms

Penicillin ® recipe in Latin

Indications and contraindications for the use of penicillin ®

Dosage and instructions for use of penicillin ® sodium salt in ampoules (injections)

Features of the use of penicillin ®

Allergy to penicillin ® and other side effects from use

What is penicillin?

What is penicillin for?

What does penicillin consist of?

Who discovered penicillin?

History of the discovery of penicillin

The effectiveness of penicillin for angina

Advantages and disadvantages of penicillin

Penicillin preparations

Rules of application

Safety, side effects and contraindications

Rules of choice: when to prescribe penicillin and when to prescribe other antibiotics

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