3.5 Penicillin
Now that we have reviewed antimicrobial basics, administration considerations, and the nursing process regarding antimicrobials, we will take a closer look at specific antimicrobial classes. Each of the following sections of this chapter is based on a class or subclass of anti-infective medications. Each section discusses the mechanism of action, indications (i.e., therapeutic effects), nursing considerations, common side effects/adverse effects, and health teaching for this class/subclass of medication.
Each section also includes a medication grid to assist students to learn key points about each medication. Basic information related to a common generic medication for each class is outlined, including administration considerations, therapeutic effects, and common side effects/adverse effects. Prototype/generic medications listed in the medication grid are also linked to a free resource from the United States National Library of Medicine called DailyMed. Because information about medication is constantly changing, nurses should always consult evidence-based resources to review current recommendations before administering specific medication. To read more about specific medications, go to the home page of DailyMed and enter the drug name in the search bar.
Penicillin
Penicillin was the first antibiotic discovered, and its detection came as a bit of an accident. In 1928 Alexander Fleming, a professor of bacteriology at St. Mary’s Hospital in London, discovered penicillin accidentally growing in a petri dish in his lab. The penicillin was the result of mold juice that had grown there inadvertently. Fleming noted that this “mold juice” inhibited the growth of Staphylococcus bacteria that was previously growing in the petri dish. Subsequently, the first antibiotic discovery was made.[1]
Mechanism of Action: Penicillins are bactericidal and kill bacteria by interfering with the synthesis of proteins needed in their cellular walls.[2] When the bacterial cell wall is impaired, the cell is rapidly broken down and destroyed.
Indications: Penicillins are prescribed to treat a variety of infectious processes such as Streptococcal infections, Pneumococcal infections, and Staphylococcal infections. Penicillins may be administered orally, IV, or intramuscularly.
Nursing Considerations: Clients receiving penicillins are at risk for developing superinfections such as C-diff or yeast infections. Probiotics may be encouraged to prevent these superinfections.
There is a cross-sensitivity for clients allergic to cephalosporins, meaning they may also have an allergic reaction to penicillin. Additionally, clients who are prescribed high doses of penicillin may experience significant coagulation abnormalities.[3] Other notable drug interactions include the use of diuretic therapy with penicillin. Penicillin contains a significant amount of potassium, so clients receiving potassium-sparing diuretics or potassium supplementation should be monitored for sign