Antimicrobials
3.6 Penicillins
Now that we have reviewed antimicrobial basics, common bacterial infections and the nursing process when administering antimicrobials, and general administration considerations, we will take a closer look at specific antimicrobial classes and administration considerations, therapeutic effects, adverse effects, and specific teaching needed for each class of antimicrobials. 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, specific administration considerations, and common client teaching for this class/subclass of medication. Each section is then followed by a medication table with a common generic medication and its specific administration considerations, therapeutic effects, and side effects/adverse effects for this medication.
Penicillins
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]
Indications for Use
Penicillins are prescribed to treat a variety of infectious processes such as Streptococcal infections, Pneumococcal infections, and Staphylococcal infections. They are considered broad-spectrum for gram-positive bacteria, but have little effectiveness for gram-negative bacteria. Penicillins may be administered orally, IV, or intramuscularly.
Mechanism of Action
Penicillins are bactericidal and kill bacteria by interfering with the synthesis of proteins needed in their cellular walls. When the bacterial cell wall is impaired, the cell is rapidly broken down and destroyed.
Nursing Considerations Across the Lifespan
Penicillins are considered safe for children, with dosages varying based on pediatric clients’ weight. No dosage adjustment is required for clients with hepatic or renal impairment. Penicillins can be used during pregnancy.
Specific Administration Considerations
In addition to general antimicrobial administration considerations, it is important to monitor clients who receive penicillins for signs of superinfections such as C-diff or yeast infections. There is also a cross-sensitivity for clients allergic to cephalosporins. It is important to remember that clients who are prescribed high doses of penicillin may experience significant coagulation abnormalities.[2] Other notable drug interactions include the use of diuretic therapy with penicillin. Penicillin contains a significant amount of potassium. Clients receiving potassium-sparing diuretics or supplementation should be monitored for signs of hyperkalemia. Penicillin is best