Penicillins administration

Additionally, some patients may experience fever, chills, tachycardia, and tachypnea, a condition commonly known as the Jarisch-Herxheimer reaction. Postulated to occur secondary to spirochete lysis and proinflammatory cytokine cascades, this reaction may transpire as early as 2 hours after penicillin administration and usually resolves within 24 hours. Treatment is supportive and may include antipyretic and antiinflammatory agents, as well as fluid resuscitation and bed rest. 

Lack of previous exposure is not the same as lack of history of previous exposure, and first dose reactions are among the most dramatic. Exposure is not necessarily medical, e.g. penicillins may occur in dairy products following treatment of mastitis in cows (despite laws to prevent this), and penicillin antibodies are commonly present in those who deny ever having received the drug. Immune responses to drugs may be harmful (allergy) or harmless the fact that antibodies are produced does not mean a patient will necessarily respond to re-exposure with dinical manifestations most of the UK population has antibodies to penicillins but, fortunately, comparatively few react clinically to penicillin administration. 

Petz LD, Fudenberg HH. Coombs-positive hemolytic anemia caused by penicillin administration. N Engl J Med 1966 274(4) 17I-8. 

Concomitant penicillin administration has been reported to exacerbate the hematological toxicity of low-dose methotrexate (143). This could have been due to inhibition of the tubular secretion of methotrexate. 

Explain the occurrence of pseudomembranous colitis with penicillin administration. 

Discuss the changes in electrolyte balance seen with penicillin administration. 

The development of new antibiotics to combat resistance, and to provide easier oral administration and improved pharmacokinetics has been successful through synthetic modifications. This approach has been particularly rewarding in the area of P-lactams. The commercial importance of the P-lactams is evident from Table 3 which gives the market share of antibacterials. Fully 62% of the 1989 world antibacterial market belonged to the cephalosporin and penicillin P-lactams (20). 

The cephalosporins generally cause few side effects (80,132,219—221). Thrombophlebitis occurs as a result of intravenous administration of all cephalosporins. Hypersensitivity reactions related to the cephalosporins are the most common side effects observed, but these are less common than found with the penicillins. Clinically only about 5—10% of patients with allergic reactions to the penicillins manifest the same reactions to the cephalosporins, and data would contradict any tme cross-reactivity to cephalosporins in patients who have previously reacted to penicillin (80,132,219). 

Tetracyclines are used as alternative dnigs in a variety of circumstances when the patient is unable to take the dnig of choice, eg, in patients allergic to penicillin (88,89). Tetracyclines are widely known to cause staining of teeth (and are therefore contra-indicated in children developing permanent teeth), photosensitivity, and, in the case of minocycline, vestibular toxicity. Details of these adverse effects and others associated with administration of tetracyclines have been comprehensively reviewed (96—101). 

The importance of the penicillins as a class of heterocyclic compounds derives primarily from their effectiveness in the treatment of bacterial infections in mammals (especially humans). It has been estimated that, in 1980, the worldwide production of antibiotics was 25 000 tons and, of this, approximately 17 000 tons were penicillins (81MI51103). The Food and Drug Administration has estimated that, in 1979 in the U.S.A., 30.1 x 10 prescriptions of penicillin V and 44.3 x 10 prescriptions of ampicillin/amoxicillin were dispensed. This level of usage indicates that, compared to other methods of dealing with bacterial infection, the cost-benefit properties of penicillin therapy are particularly favorable. Stated differently, penicillin treatment leads to the elimination of the pathogen in a relatively high percentage of cases of bacterial infection at a relatively low cost to the patient in terms of toxic reactions and financial resources. 

Widespread clinical acceptance continues to be accorded to the cephalosporins, and the field is extremely active as firms search for the ultimate contender. Among the characteristics desired is retention of the useful features of the older members (relatively broad spectrum, less antigenicity than the penicillins, relative insensitivity toward 3-lactamases, and convenience of administration) while adding better oral activity and broader antimicrobial activity (particularly potency against Pseudomonas, anaerobes, meningococci, cephalosporinase-carrying organisms, and the like). To a considerable extent these objectives have been met, but the price to the patient has been dramatically increased. 

Like penicillins, cephalosporins are (3-lactam antibiotics and interfere with bacterial cell wall synthesis. A very large number of cephalosporins are available for clinical use. They differ in their route of administration and clinical use. 

The co-administration of drugs which inhibit the transporters involved in renal tubular secretion can reduce the urinaty excretion of drugs which are substrates of the transporter, leading to elevated plasma concentrations of the drugs. For example, probenecid increases the plasma concentration and the duration of effect of penicillin by inhibiting its renal tubular secretion. It also elevates the plasma concentration of methotrexate by the same mechanism, provoking its toxic effects. 

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. 

The expected outcomes of the patient depend on the reason for administration of penicillin but may include an optimal response to drug therapy, management of common adverse reactions, and an understanding of and compliance with the prescribed drug regimen. 

IM PA I RED ORAL M UCOUS M EM 0 RAN ES. The administration of oral penicillin may result in a fungal superinfection in tiie oral cavity. With impaired oral mucous membranes there will be varying degrees of inflamed oral mucous membranes, swollen and red tongue, swollen gums, and pain in tiie mouth and throat. To detect this problem early, tiie nurse inspects tiie patient s mouth... 

The effects of the progestins are decreased when administered with anticonvulsants, barbiturates, or rifampin. Administration of the penicillins or tetracyclines with the oral contraceptives decreases the effects of the oral contraceptives. 

Serum potassium concentration Is Increased by the concurrent administration of Intravenous potassium penicillin 6. The penicillin preparation contains 1.7 mmol of potassium per million units. Thus, a patient receiving 10 million units of the antibiotic receives 17 mmol (m q.) of potassium. 

Benzylpenicillin is rapidly absoibed and rapidly excreted However, certain sparingly soluble salts of benzylpenicillin (benzathine, benethamine and procaine) slowly release penicillin into the circulation over a period of time, thus giving a continuous high concentration in the blood. Simultaneous administration of benzylpenicillin (see Fortified Proeaine Penieillin, BP) may be given initially. 

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