Penicillin

Aka: Penicillin

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II. Background

  1. Penicillin was first discovered by Alexander Fleming in 1928
    1. Observed inhibited growth of Staphylococcus Aureus on an agar plate
    2. Agar was contaminated with growth of Penicillium mold (Penicillium notatum)
  2. Penicillin was first used in humans in 1941
    1. Introduced to the pharmaceutical market in 1946

III. Types: Penicillin Categories

  1. Natural Penicillins (covers Streptococci and Anaerobes)
    1. Original Natural Penicillins
      1. Penicillin V or Phenoxymethylpenicillin (oral)
      2. Penicillin G or Benzylpenicillin (IV)
    2. Semisynthetic Penicillins derived from Penicillin G for long duration after IM Injection
      1. Procaine Penicillin G
      2. Benzathine Penicillin G
  2. Penicillinase-Resistant Semisynthetic Penicillin (covers streptococci and MSSA)
    1. Cloxacillin
    2. Dicloxacillin
    3. Methicillin
    4. Nafcillin
    5. Oxacillin
  3. Aminopenicillins (covers streptococci and Gram Negative Bacteria)
    1. Amoxicillin (oral) or Ampicillin (IV)
    2. Augmentin (oral) or Unasyn (IV)
  4. Extended Spectrum Penicillin (covers streptococci, Gram Negatives and Pseudomonas)
    1. Piperacillin Tazobactam (Zosyn)
    2. Piperacillin
    3. Carbenicillin
    4. Ticarcillin

IV. Mechanism: Penicillins

  1. See Beta Lactam
  2. Penicillin inhibits cell wall synthesis
  3. All Penicillins contain a Beta Lactam ring central to their functionality
    1. Beta Lactam ring is also found in Cephalosporins and carbopenems
    2. In addition, all Penicillins also have a thiazoldine ring and a side chain
  4. Beta Lactam ring binds Penicillin binding Protein, which interferes with peptidoglycan synthesis
    1. Inhibition of peptidoglycan synthesis blocks cross-linking of the Bacterial cell wall components
  5. Extended spectrum agents include additional side chains to combat resistance
    1. Bulky side chains decrease Penicillinase resistance

V. Mechanism: Penicillin Resistance Mechanisms

  1. Bacterial Production of Beta Lactamase
    1. Staphylococcus Aureus
    2. Staphylococcus Epidermidis
    3. Neisseria gonorrhoeae
    4. Moraxella catarrhalis
  2. Bacterial Alteration in Penicillin-binding Proteins
    1. Streptococcus Pneumoniae (Pneumococcus)

VI. Adverse Effects

  1. Anaphylaxis and other Hypersensitivity Reactions
    1. See Penicillin Allergy
  2. Nephritis
  3. Hyperkalemia
  4. Neutropenia
  5. Seizures
    1. Beta Lactam ring is similar to GABA and may inhibit GABA activity

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Cost: Medications

penicillin (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
PENICILLIN VK 125 MG/5 ML SOLN Generic $0.07 per ml
PENICILLIN VK 250 MG TABLET Generic $0.06 each
PENICILLIN VK 250 MG/5 ML SOLN Generic $0.05 per ml
PENICILLIN VK 500 MG TABLET Generic $0.10 each
FPNotebook does not benefit financially from showing this medication data or their pharmacy links. This information is provided only to help medical providers and their patients see relative costs. Insurance plans negotiate lower medication prices with suppliers. Prices shown here are out of pocket, non-negotiated rates. See Needy Meds for financial assistance information. GoodRx is another tool for finding lower drug prices.

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