Penicillin (carboxypenicillin)
Gram positive bacteria: Streptococcus spp., Listeria monocytogenes
Gram negative bacteria: Pseudomonas aeruginosa, Enterobacter, Providencia, Morganella, Proteus, 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
Cmax: 223mcg/ml; Half-life: 1.1 hours; Table 6
Hematologic: anemia, thrombocytopenia, neutropenia, agranulocytosis
CNS: seizures
Renal: nephrotoxicity, interstitial nephritis
Hepatic: transient increases in transaminases
Other: Jarisch-Herxheimer Reaction (fever, chills, sweating, tachycardia, hyperventilation, flushing, and myalgia)
Adult: 382-764 mg po qid
Pediatric: No data
Disease state based dosing:
Renal failure: No data
Anaphylaxis to carbenecillin or other penicillins
Cephalosporin hypersensitivity
Congestive heart failure or hypertension (the sodium content of high doses of parenteral carbenicillin should be considered in patients who require sodium restriction).
Contraceptives - decreased contraceptive effectiveness
Live Typhoid Vaccine - decreased immunological response to the typhoid vaccine
Probenecid - increased carbenecillin 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, diarrhea, skin rash
CARBAPEN (CSL - AUSTRALIA)
CARBECIN (Sanfer - MEXICO)
CARINDAPEN (Pfizer - GERMANY)
GEOCILLIN (Pfizer - USA)
GEOPEN (PFIZER – INDIA, CANADA, HONG KONG, USA, ITALY, SPAIN)
MYCICLID - (Wayne - MEXICO)
PYOPEN (WYETH - CANADA)
PYOPEN (Beecham – FRANCE, CANADA, UK)
SAFEPEN (Beecham - SPAIN)
UNIPEN (Pfizer - SPAIN)
UROCARF (SPA - ITALY)
UTICILLIN (Beecham Research, UK)