02-26-24

DRUG STUDY (BENZYLPENICILLIN)

Benzylpenicillin is a penicillin used for the treatment of infections caused by gram-
positive cocci, in particular streptococcal infections. This form of penicillin is typically used in
intravenous or long-acting injectable formulations due to poor oral absorption.

Brand Names
 Bicillin, Bicillin L-A, Pfizerpen
 Generic Name
 Benzylpenicillin

Background
Benzylpenicillin (Penicillin G) is narrow spectrum antibiotic used to treat infections
caused by susceptible bacteria. It is a natural penicillin antibiotic that is administered
intravenously or intramuscularly due to poor oral absorption. Penicillin G may also be used in
some cases as prophylaxis against susceptible organisms.

Indication
For use in the treatment of severe infections caused by penicillin G-susceptible
microorganisms when rapid and high penicillin levels are required such as in the treatment of
septicemia, meningitis, pericarditis, endocarditis and severe pneumonia.

Contraindications and precautions

 Caution in preterm infants, especially extreme immaturity.
 Caution in infants with liver, renal or gastrointestinal disease.
 Consider sodium load in renal failure - a dose of 300mg/kg/day provides 0.90
mmol/kg/day of sodium.

Pharmacodynamics
Penicillin G is a penicillin beta-lactam antibiotic used in the treatment of bacterial
infections caused by susceptible, usually gram-positive, organisms. The name "penicillin" can
either refer to several variants of penicillin available, or to the group of antibiotics derived from
the penicillins. Penicillin G has in vitro activity against gram-positive and gram-negative aerobic
and anaerobic bacteria. The bactericidal activity of penicillin G results from the inhibition of cell
wall synthesis and is mediated through penicillin G binding to penicillin binding proteins (PBPs).
Penicillin G is stable against hydrolysis by a variety of beta-lactamases, including penicillinases,
and cephalosporinases and extended spectrum beta-lactamases.

Mechanism of action
By binding to specific penicillin-binding proteins (PBPs) located inside the bacterial cell
wall, penicillin G inhibits the third and last stage of bacterial cell wall synthesis. Cell lysis is then
mediated by bacterial cell wall autolytic enzymes such as autolysins; it is possible that penicillin
G interferes with an autolysin inhibitor.

Absorption
Rapidly absorbed following both intramuscular and subcutaneous injection. Initial blood
levels following parenteral administration are high but transient. Oral absorption in fasting,
healthy humans is only about 15-30% as it is very susceptible to acid-catalyzed hydrolysis.

Route of elimination
Penicillin G is eliminated by the kidneys. Nonrenal clearance includes hepatic
metabolism and, to a lesser extent, biliary excretion.

Possible adverse effects

 Venous irritation, soft tissue injury at site of IV injection.
 Pain, soft tissue injury at site of IM injection.
 Gastrointestinal disturbance (nausea, vomiting, diarrhoea).
 Non specific rashes and skin eruptions.
 Fever, pruritis, urticaria.
 Seizures with high doses (greater than 400 mg/kg/day) and rapid infusion

Nursing considerations
 Observe IV site carefully for extravasation during administration.
 Observe for signs of adverse effects.
 Observe for hypernatraemia.