Penicillin (aminopenicillin)
Gram positive bacteria: Streptococcus spp., Enterococcus, Listeria monocytogenes
Gram negative bacteria: H. influenzae, E. coli, Proteus mirabilis, Salmonella spp., Shigella spp.
Exerts bactericidal activity via inhibition of bacterial cell wall synthesis by binding one or more of the penicillin binding proteins (PBPs). Exerts bacterial autolytic effect by inhibition of certain PBPs related to the activation of a bacterial autolytic process.
Penicillins produce time-dependent killing
Oral bioavailability: 98%; Total protein binding: 17 to 20%; Metabolism: Rapidly hydrolyzed to ampicillin (active metabolite); extensive metabolism in intestinal wall; Excretion: predominant renal excretion (73%); Volume of distribution: 27 L
Hematologic: anemia, thrombocytopenia, neutropenia, agranulocytosis
CNS: seizures
Renal: nephrotoxicity
Hepatic: transient increases in transaminases
Other: Jarisch-Herxheimer Reaction (fever, chills, sweating, tachycardia, hyperventilation, flushing, and myalgia)
Adult: ³ 25 kg: Upper respiratory tract infections, Urinary tract infections, skin infections:
400 mg q12h; treat for a minimum of 48-72 hours after the patient becomes asymptomatic
Severe infections:
800 mg q12h; treat for a minimum of 48-72 hours after the patient
becomes asymptomatic
Pediatric: Upper respiratory tract infections, Urinary tract infections, skin infections:
25 mg/kg/day in two divided doses q12h; treat for a minimum of 48-72 hours after the patient becomes asymptomatic
Severe infections:
50 mg/kg/day in two divided doses q12h; treat for a minimum of 48-72 hours after the patient becomes asymptomatic
Disease state based dosing:
Renal failure: CrCl > 50 mL/min: dosing interval is every 6 hours
CrCl 10 to 50 mL/min: dosing interval is every 6 to 12 hours
CrCl < 10 mL/min: dosing interval is every 12 to 24 hours
Hepatic failure: No dosing adjustment necessary
Anaphylaxis to bacampicillin or other penicillins
Cephalosporin hypersensitivity
Patients with mononucleosis are more likely to develop a skin rash
Contraceptives - decreased contraceptive effectiveness
Live Typhoid Vaccine - decreased immunological response to the typhoid vaccine
Probenecid - increased bacampicillin levels
Category B: No evidence of risk in humans but studies inadequate.
Therapeutic: Culture and sensitivities, signs and symptoms of infection
Toxic: Periodic CBC, urinalysis, BUN, SCr, AST and ALT