Penicillin inhibits bacterial cell wall synthesis and interferes with cell wall replication of susceptible organisms, which results in cell lysis and death.
Penicillin is used in the treatment of many gram positive respiratory infections, meningitis, infectious endocarditis, scarlet fever, gas gangrene, and otitis media. It is also administered for syphilis caused by a spirochete.
Prophylactic administration is given to prevent recurrent attacks of rheumatic fever and prevention of bacterial endocarditis in patients with prosthetic heart valves, congenital heart disease, and mitral valve prolapse. Prophylaxis is usually initiated before dental procedures or any procedure which may expose the blood to direct invasion by organisms.
Be sure to administer deep IM or using Z track to reduce pain at injection site. Aspirate before injection, as injection into an artery can lead to gangrene, necrosis, and tissue sloughing. If accidental injection into a peripheral nerve occurs, patient may experience a reversible sensory and motor dysfunction of the extremity.
An allergic reaction can range from a rash to anaphylaxis. Anaphylactic reactions are often immediate and occur within 2 to 30 minutes following the administration of the medication, therefore, educate the patient to remain at the doctor's office for 30 minutes after receiving an injection to monitor for a reaction. If patient has history of penicillin allergy, they should not receive a penicillin medication again.
Skin tests are used to determine patient’s current risk. It is thought that allergy to penicillin may decrease over time. There is a small risk of cross sensitivity with cephalosporins.
Patients should wear a medic alert bracelet or carry some type of ID notifying health care personnel of allergy.
Oral penicillin medication should be taken with a full glass of water 1 hour before meals or 2 hours after. Patients need to complete the entire course of treatment. Teach the patient to report signs of allergy to health care providers, such as a skin rash, itching, or hives. Oral suspensions need to be thoroughly shaken and stored in the refrigerator.
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