Penicillin injections

Children and young adults with a history of rheumatic fever are given monthly benzathin-penicillin injections or oral penicillin to prevent recurrent attacks of rheumatic fever (secondary prevention of rheumatic cardiac disease). 

The drug is injected into the skin raising a bleb. This route is employed for vaccination e.g. BCG vaccine and for testing the sensitivity e.g. penicillin injection. 

The first challenge of the research teams was purifying penicillin by extracting the compound from the mold. Norman Heatley (1911—2004) devised extraction and purification methods to obtain quantities of penicillin sufficient for study. It was determined that penicillin was nontoxic when injected in animal subjects. In May 1940, a significant experiment took place in which eight mice injected with streptococci bacteria and half of these were treated with penicillin. The mice injected with penicillin survived and the untreated mice died after a day. Similar results were obtained with subsequent experiments as the researchers refined the amount and frequency of penicillin injections needed to combat infections in different animal subjects. 

An essential property required to obtain a physically stable suspension formulation is that the drag substance has a low solubility in the suspension vehicle. This applies to all types of suspension whether intended for oral, parenteral or inhalation delivery. Since most suspensions are aqueous, a low solubility in water is required to prevent drug dissolution and crystal growth on storage. Some drugs intended for intramuscular use are formulated as suspensions in oil (e.g. penicillin injections are formulated in sesame oil) to improve chemical stability via a reduction in solubility. 

Most patients with secondary syphilis develop the Jarisch-Herxheimer reaction, including chills, fever, headache, myalgias, and arthralgias occurring several hours after the first dose of penicillin. This is likely due to release of spirochetal antigens that induce a host reaction. Reactions usually persist for a few hours to days but do not recur with subsequent penicillin injections penicillin therapy should not be stopped. 

Items 10-11 An immunosuppressed patient was treated for a bacterial infection with a parenteral penicillin. Within a few minutes of the penicillin injection, he developed severe bronchoconstriction, laryngeal edema, and hypotension. Due to the rapid administration of epinephrine, the patient survived. Unfortunately, a year later he was treated with an antipsychotic drug and developed agranulocytosis. 

Andrade P, Pereira N, Brites MM, Gon5alo M, Figueiredo A. Nicolau livedoid dermatitis following intramuscular benzathine penicillin injection. Dermatol Online J 2010 16(12) 11. 

Karimi M, Owlia MB. Nicolau syndrome following intramuscular penicillin injection. J Coll Physicians Surg Pak 2012 22(1) 41-2. 

Bacci, R., Mathis, I. and Baduini, G. (1975) Acute transverse myelopathy caused by penicillin injection. Europ. Neurol, 13, 555. 

Duarte and colleagues used a factorial design to optimize a flow injection analysis method for determining penicillin potentiometricallyd Three factors were studied—reactor length, carrier flow rate, and sample volume, with the high and low values summarized in the following table. 

Acylation of 7-ACA with 2-thienylacetylchloride gives the amide cephalothin (43). Displacement of the allylic acetyl group by pyridine affords the corresponding pyridinium salt cephalori-dine (44). Both these compounds constitute useful injectable antibiotics with some activity against bacteria resistant to penicillin by reason of penicillinase production. 

Common adverse reactions include mild nausea, vomiting, diarrhea, sore tongue or mouth, fever, and pain at injection site. Penicillin can stimulate a hypersen-... 

Other adverse reactions associated with penicillin are hematopoietic changes such as anemia, thrombocytopenia (low platelet count), leukopenia (low white blood cell count), and bone marrow depression. When penicillin is given orally, glossitis (inflammation of the tongue), stomatitis (inflammation of die mouth), dry mouth, gastritis, nausea, vomiting, and abdominal pain occur. When penicillin is given intramuscularly (IM), there may be pain at die injection site Irritation of the vein and phlebitis (inflammation of a vein) may occur witii intravenous (IV) administration. 

When administering penicillin IM, the nurse warns the patient that there may be a stinging or burning sensation at tiie time the drug is injected into the muscle. Discomfort at the time of injection occurs because the drug is irritating to the tissues. The nurse inspects previous areas used for injection for continued redness, soreness, or other problems. It is important to inform the primary health care provider if previously used areas for injection appear red or the patient reports pain in the area... 

After administering penicillin IM in the outpatient setting, the nurse asks the client to wait in the area for at least 30 minutes Anaphylactic reactions are most likely to occur within 30 minutesafter injection. 

The well-known adverse reaction formerly often observed after intramuscular injection of clemizol penicilUn in the treatment of syphilis with anaphylaxis-like symptoms plus CNS involvement in the absence of immimological sensitization to penicillin was called the Hoigne syndrome or embolic-toxic reaction, and might be explained by intravasal appUcation of LA with subsequent toxic effects [8]. 

Penicillin G benzathine 1.2 million units 600,000 units (if under 27 kg) 1 IM dose Useful for nonadherence or emesis painful injection... 

In contrast, parenteral suspensions have relatively low solids contents, usually between 0.5 and 5%, with the exception of insoluble forms of penicillin in which concentrations of the antibiotic may exceed 30%. These sterile preparations are designed for intramuscular, intradermal, intralesional, intraarticular, or subcutaneous injection. Syringeability is an important factor to be taken into consideration with injectable dosage forms. The viscosity of a parenteral suspension should be sufficiently low to facilitate injection. Common suspending vehicles include preserved isotonic saline solution or a parenterally acceptable vegetable oil. Ophthalmic and optic suspensions that are instilled into the eye/ear must also be prepared in a sterile manner. The vehicles are essentially isotonic and aqueous in composition. The reader should refer to Chapter 12 for further discussion on parenteral products. 

Two basic methods are used to prepare parenteral suspensions (a) sterile vehicle and powder are combined aseptically, or (b) sterile solutions are combined and the crystals formed in situ. Examples of these procedures may be illustrated using Penicillin G Procaine Injectable Suspension USP and Sterile Testosterone Injectable Suspension USP. 

Intramuscular Route. The IM route is frequently used for drugs dissolved in oily vehicles or for those in a microcrystalline formulation that are poorly soluble in water (e.g., procaine or penicillin G). Advantages include rapid absorption (often in under 30 min), the opportunity to inject a relatively large amount of solution, and a reduction in pain and local irritation compared with SC injections. Potential comphcations include infections and nerve damage. The latter usually results from the choice of an incorrect site for injection. 

Certain medications including penicillins and other antibiotics are unstable when stored in solution form and are therefore packaged in powder form. The dry powders must be reconstituted with a sterile diluent such as sterile water for injection or sterile sodium chloride (normal saline) solution. Instructions supplied with the vial state the volume of diluent which should be added. The resulting volume of the reconstituted drug and the approximate average concentration per milliliter are provided in the label or the package information sheet (package insert). 

The penicillins, cephalosporins, carbapenems, and monobactams all work in basically the same way. However, they have different therapeutic uses which derive from several factors which organisms are susceptible to which agent, which may be taken orally and which mnst be injected, which do and do not penetrate into the central nervons system, and so forth. The target of these antibiotics is the bacterial cell wall. 

Electrochemical immunosensors are a powerful tool for the analysis of antibacterials in food and different configurations have been presented during recent years. For example, an amperometric immunosensor was reported by Wu et al. [182], for penicillin quantification in milk, with a linear range from 0.25 to 3 ng/ml and a limit of detection of 0.3 pg/L [182]. Other types of transduction have been also explored, like a label-free impedimetric flow injection immunosensor for the detection of penicillin G. 

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