Side effects of penicillin

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The side effects of penicillin are bodily responses to penicillin and closely related antibiotics that do not relate directly to its effect on bacteria. A side effect is an effect that is not intended with normal dosing. [1] Some of these reactions are visible and some occur in the body's organs or blood. Penicillins are a widely used group of medications that are effective for the treatment of a wide variety of bacterial infections in human adults and children as well as other species. Some side effects are predictable, of which some are common but not serious, some are uncommon and serious and others are rare. [2] The route of administration of penicillin can have an effect on the development of side effects. An example of this is irritation and inflammation that develops at a peripheral infusion site when penicillin is administered intravenously. In addition, penicillin is available in different forms. There are different penicillin medications (penicillin G benzathine, penicillin G potassium, Penicillin G sodium, penicillin G procaine, and penicillin V) [3] as well as a number of β-lactam antibiotics derived from penicillin (e.g. amoxicillin).

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Side effects may only last for a short time and then go away. Side effects can be relieved in some cases with non pharmacological treatment. [4] Some side effects require treatment to correct potentially serious and sometimes fatal reactions to penicillin. Penicillin has not been found to cause birth defects. [5]

Allergies and cross sensitivities

Many people have indicated that they have a side effect related to an allergic reaction to penicillin. It has been proposed that as many as 90% of those claiming to have an allergy to penicillin are able to take it and do not have a true allergy. Research has suggested that having penicillin allergy incorrectly noted in the medical records can have negative consequences. [6] [7]

Identifying an allergy to penicillin requires a hypersensitivity skin test, which diagnoses IgE-mediated immune responses caused by penicillin. This test is typically performed by an allergist who uses a skin-prick and intradermal injection of penicilloyl-polylysine, a negative control (normal saline), and a positive control (histamine). [8]

A small proportion of people who are allergic to penicillins also have similar cross sensitivities to other antibiotics such as cephalosporins. If someone has developed side effects when taking penicillin, these side effects may develop with a new medication even though the person has not taken the new medication before. Those medications that may cause a cross sensitivity reaction are: carbapenems, ampicillin, cefazolin, cephalosporins and cloxacillin. [9] [8] [10]

Risk assessment and "de-labelling"

Of patients with documented penicillin allergy, approximately 95% will return a negative penicillin skin-prick test [11] but patients carrying a penicillin allergy label are significantly more likely to experience worse outcomes. [12] As such, it is important for clinicians to verify the nature of reported penicillin allergy at admission and de-label when appropriate.

For this purpose, clinical risk assessment tools have been developed such as "PEN-FAST":

Patients scoring 4 or greater have a high (50%) probability of testing positive for penicillin allergy. [13]

Side effects in adults

Common adverse drug reactions (≥ 1% of people) associated with use of the penicillins include diarrhea, hypersensitivity, nausea, rash, neurotoxicity, urticaria (hives), and superinfection (including candidiasis). Infrequent adverse effects (0.1–1% of people) include fever, vomiting, erythema, dermatitis, angioedema, seizures (especially in people with epilepsy), and pseudomembranous colitis. [14] [ needs update ]

Very common (>10% incidence)

Common (1-10% incidence)

Uncommon (<1%)

Life threatening

Rare (<0.1%)

High doses

When penicillin is used at high doses hypokalemia, metabolic acidosis, and hyperkalemia can occur. [17] Developing hypernatremia after administering high doses of penicillin can be a serious side effect. [10]

Side effects from other medications

The side effects of penicillin can be altered by taking other medications at the same time. Taking oral contraceptives along with penicillin may lower the effects of the contraceptive. When probenecid is used concurrently with penicillin, kidney excretion of probenecid is decreased resulting in higher blood levels of penicillin in the circulation. In some instances, this would be an intended therapeutic effect. In other instances, this is an unintended side effect. Neomycin can lower the absorption of penicillin from the gastrointestinal tract resulting in lower than expected levels of penicillin in the circulation. This side effect may result in an ineffective therapeutic effect of penicillin. When methotrexate is administered with penicillin, toxicity may occur related to methotrexate. [10]

In animals

Animals are often treated with antibiotics for infections they have developed. There are side effects of penicillin when it is used in animals. MRSA may develop in pets as a consequence of treatment. [18] [19] Nutritional deficiencies can develop in pets as a side effect. [20] Destruction of the normal protective flora of beneficial bacteria can occur in dogs and horses. [21] [22] Dogs may have side effects that include: joint pain, loss of appetite, vomiting, flatulence (intestinal gas), fungal infections and digestive problems. [23] Like humans, dogs can have a similar side effect related to developing a serious allergy. A serious and possibly fatal anaphylactic can occur. Side effects that are concurrent with anaphylaxis include: breathing problems and shock.[ citation needed ]

Cats and dogs have had adverse reactions to intravenous penicillin that include: hypothermia, pruritus, hypotension, tremors, seizures, blindness, vocalization, agitation, cardiac arrest and transient loss of vision. [24]

Other side effects

Penicillin is known to become less effective as strains of bacteria become resistant. [25]

Related Research Articles

<span class="mw-page-title-main">Ampicillin</span> Antibiotic

Ampicillin is an antibiotic belonging to the aminopenicillin class of the penicillin family. The drug is used to prevent and treat a number of bacterial infections, such as respiratory tract infections, urinary tract infections, meningitis, salmonellosis, and endocarditis. It may also be used to prevent group B streptococcal infection in newborns. It is used by mouth, by injection into a muscle, or intravenously.

<span class="mw-page-title-main">Amoxicillin</span> Beta-lactam antibiotic

Amoxicillin is an antibiotic medication belonging to the aminopenicillin class of the penicillin family. The drug is used to treat bacterial infections such as middle ear infection, strep throat, pneumonia, skin infections, odontogenic infections, and urinary tract infections. It is taken by mouth, or less commonly by injection.

<span class="mw-page-title-main">Anaphylaxis</span> Life-threatening allergic reaction

Anaphylaxis is a serious, potentially fatal allergic reaction and medical emergency that is rapid in onset and requires immediate medical attention regardless of use of emergency medication on site. It typically causes more than one of the following: an itchy rash, throat closing due to swelling that can obstruct or stop breathing; severe tongue swelling that can also interfere with or stop breathing; shortness of breath, vomiting, lightheadedness, loss of consciousness, low blood pressure, and medical shock. These symptoms typically start in minutes to hours and then increase very rapidly to life-threatening levels. Urgent medical treatment is required to prevent serious harm and death, even if the patient has used an epipen or has taken other medications in response, and even if symptoms appear to be improving.

<span class="mw-page-title-main">Ertapenem</span> Antibiotic medication

Ertapenem, sold under the brand name Invanz, is a carbapenem antibiotic medication used for the treatment of infections of the abdomen, the lungs, the upper part of the female reproductive system, and the diabetic foot.

<span class="mw-page-title-main">Sulfonamide (medicine)</span> Molecular moiety or the drug class that uses it

Sulfonamide is a functional group that is the basis of several groups of drugs, which are called sulphonamides, sulfa drugs or sulpha drugs. The original antibacterial sulfonamides are synthetic (nonantibiotic) antimicrobial agents that contain the sulfonamide group. Some sulfonamides are also devoid of antibacterial activity, e.g., the anticonvulsant sultiame. The sulfonylureas and thiazide diuretics are newer drug groups based upon the antibacterial sulfonamides.

<span class="mw-page-title-main">Aztreonam</span> Chemical compound

Aztreonam, sold under the brand name Azactam among others, is an antibiotic used primarily to treat infections caused by gram-negative bacteria such as Pseudomonas aeruginosa. This may include bone infections, endometritis, intra abdominal infections, pneumonia, urinary tract infections, and sepsis. It is given by intravenous or intramuscular injection or by inhalation.

<span class="mw-page-title-main">Cefazolin</span> Antibiotic medication

Cefazolin, also known as cefazoline and cephazolin, is a first-generation cephalosporin antibiotic used for the treatment of a number of bacterial infections. Specifically it is used to treat cellulitis, urinary tract infections, pneumonia, endocarditis, joint infection, and biliary tract infections. It is also used to prevent group B streptococcal disease around the time of delivery and before surgery. It is typically given by injection into a muscle or vein.

<span class="mw-page-title-main">Ceftriaxone</span> Antibiotic medication

Ceftriaxone, sold under the brand name Rocephin, is a third-generation cephalosporin antibiotic used for the treatment of a number of bacterial infections. These include middle ear infections, endocarditis, meningitis, pneumonia, bone and joint infections, intra-abdominal infections, skin infections, urinary tract infections, gonorrhea, and pelvic inflammatory disease. It is also sometimes used before surgery and following a bite wound to try to prevent infection. Ceftriaxone can be given by injection into a vein or into a muscle.

<span class="mw-page-title-main">Cefalexin</span> Beta-lactam antibiotic

Cefalexin, also spelled cephalexin, is an antibiotic that can treat a number of bacterial infections. It kills gram-positive and some gram-negative bacteria by disrupting the growth of the bacterial cell wall. Cefalexin is a β-lactam antibiotic within the class of first-generation cephalosporins. It works similarly to other agents within this class, including intravenous cefazolin, but can be taken by mouth.

<span class="mw-page-title-main">Eye drop</span> Liquid applied directly to the eye

Eye drops or eyedrops are liquid drops applied directly to the surface of the eye usually in small amounts such as a single drop or a few drops. Eye drops usually contain saline to match the salinity of the eye. Drops containing only saline and sometimes a lubricant are often used as artificial tears to treat dry eyes or simple eye irritation such as itching or redness. Eye drops may also contain one or more medications to treat a wide variety of eye diseases. Depending on the condition being treated, they may contain steroids, antihistamines, sympathomimetics, beta receptor blockers, parasympathomimetics, parasympatholytics, prostaglandins, nonsteroidal anti-inflammatory drugs (NSAIDs), antibiotics, antifungals, or topical anesthetics.

<span class="mw-page-title-main">Cefixime</span> A third generation cephalosporin antibiotic

Cefixime, sold under the brand name Suprax among others, is an antibiotic medication used to treat a number of bacterial infections. These infections include otitis media, strep throat, pneumonia, urinary tract infections, gonorrhea, and Lyme disease. For gonorrhea typically only one dose is required. In the United States it is a second-line treatment to ceftriaxone for gonorrhea. It is taken by mouth.

<span class="mw-page-title-main">Cefaclor</span> Chemical compound

Cefaclor, sold under the trade name Ceclor among others, is a second-generation cephalosporin antibiotic used to treat certain bacterial infections such as pneumonia and infections of the ear, lung, skin, throat, and urinary tract. It is also available from other manufacturers as a generic.

<span class="mw-page-title-main">Piperacillin/tazobactam</span> Combination antibiotic medication

Piperacillin/tazobactam, sold under the brand name Tazocin among others, is a combination medication containing the antibiotic piperacillin and the β-lactamase inhibitor tazobactam. The combination has activity against many Gram-positive and Gram-negative bacteria including Pseudomonas aeruginosa. It is used to treat pelvic inflammatory disease, intra-abdominal infection, pneumonia, cellulitis, and sepsis. It is given by injection into a vein.

Ampicillin/sulbactam is a fixed-dose combination medication of the common penicillin-derived antibiotic ampicillin and sulbactam, an inhibitor of bacterial beta-lactamase. Two different forms of the drug exist. The first, developed in 1987 and marketed in the United States under the brand name Unasyn, generic only outside the United States, is an intravenous antibiotic. The second, an oral form called sultamicillin, is marketed under the brand name Ampictam outside the United States, and generic only in the United States. Ampicillin/sulbactam is used to treat infections caused by bacteria resistant to beta-lactam antibiotics. Sulbactam blocks the enzyme which breaks down ampicillin and thereby allows ampicillin to attack and kill the bacteria.

<span class="mw-page-title-main">Flucloxacillin</span> Penicillin

Flucloxacillin, also known as floxacillin, is an antibiotic used to treat skin infections, external ear infections, infections of leg ulcers, diabetic foot infections, and infection of bone. It may be used together with other medications to treat pneumonia, and endocarditis. It may also be used prior to surgery to prevent Staphylococcus infections. It is not effective against methicillin-resistant Staphylococcus aureus (MRSA). It is taken by mouth or given by injection into a vein or muscle.

<span class="mw-page-title-main">Dicloxacillin</span> Chemical compound

Dicloxacillin is a narrow-spectrum β-lactam antibiotic of the penicillin class. It is used to treat infections caused by susceptible (non-resistant) Gram-positive bacteria. It is active against beta-lactamase-producing organisms such as Staphylococcus aureus, which would otherwise be resistant to most penicillins. Dicloxacillin is available under a variety of trade names including Diclocil (BMS).

<span class="mw-page-title-main">Oxacillin</span> Chemical compound

Oxacillin is a narrow-spectrum beta-lactam antibiotic of the penicillin class developed by Beecham.

<span class="mw-page-title-main">Benzylpenicillin</span> Antibiotic medication

Benzylpenicillin, also known as penicillin G (PenG) or BENPEN, is an antibiotic used to treat a number of bacterial infections. This includes pneumonia, strep throat, syphilis, necrotizing enterocolitis, diphtheria, gas gangrene, leptospirosis, cellulitis, and tetanus. It is not a first-line agent for pneumococcal meningitis. Due to benzylpenicillin's limited bioavailability for oral medications, it is generally taken as an injection in the form of a sodium, potassium, benzathine, or procaine salt. Benzylpenicillin is given by injection into a vein or muscle. Two long-acting forms benzathine benzylpenicillin and procaine benzylpenicillin are available for use by injection into a muscle only.

<span class="mw-page-title-main">Benzathine benzylpenicillin</span> Antibiotic

Benzathine benzylpenicillin, also known as benzathine penicillin G (BPG), is an antibiotic medication useful for the treatment of a number of bacterial infections. Specifically it is used to treat strep throat, diphtheria, syphilis, and yaws. It is also used to prevent rheumatic fever. It is given by injection into a muscle. It is known as "Peanut Butter Shot" in US military slang due to its appearance.

There are many circumstances during dental treatment where antibiotics are prescribed by dentists to prevent further infection. The most common antibiotic prescribed by dental practitioners is penicillin in the form of amoxicillin, however many patients are hypersensitive to this particular antibiotic. Therefore, in the cases of allergies, erythromycin is used instead.

References

  1. ↑ "Definitions" (PDF). The World health organization. Retrieved May 20, 2017.
  2. ↑ Vallerand 2017, pp. 3–4.
  3. ↑ Karch 2017, p. 115.
  4. 1 2 3 4 "Penicillin (Oral Route, Injection Route, Intravenous Route, Intramuscular Route) Side Effects - Mayo Clinic". www.mayoclinic.org. Retrieved 18 May 2017.
  5. ↑ "Penicillin use during pregnancy not linked to birth defects". 16 December 2009. Retrieved 19 May 2017.
  6. ↑ "Are you sure you are allergic to penicillin?". NIHR Evidence. 2022-01-20. doi:10.3310/alert_48839. S2CID   246149945 . Retrieved 2022-06-24.
  7. ↑ Wanat, Marta; Anthierens, Sibyl; Butler, Christopher C.; Savic, Louise; Savic, Sinisa; Pavitt, Sue H.; Sandoe, Jonathan A. T.; Tonkin-Crine, Sarah (2021-06-11). "Management of penicillin allergy in primary care: a qualitative study with patients and primary care physicians". BMC Family Practice. 22 (1): 112. doi: 10.1186/s12875-021-01465-1 . ISSN   1471-2296. PMC   8194168 . PMID   34116641.
  8. 1 2 Gonzalez-Estrada, A.; Radojicic, C. (2015). "Penicillin allergy: A practical guide for clinicians". Cleveland Clinic Journal of Medicine. 82 (5): 295–300. doi: 10.3949/ccjm.82a.14111 . ISSN   0891-1150. PMID   25973877. S2CID   6717270.
  9. ↑ "Pharmaceutical Sciences CSU Parenteral Antibiotic Allergy cross-sensitivity chart" (PDF). Vancouver Acute Pharmaceutical Sciences, Vancouver Hospital & Health Sciences Centre. 2016. Archived from the original (PDF) on April 17, 2016. Retrieved May 19, 2017.
  10. 1 2 3 4 5 6 Vallerand 2017, pp. 989–994.
  11. ↑ Sacco, K. A.; Bates, A.; Brigham, T. J.; Imam, J. S.; Burton, M. C. (September 2017). "Clinical outcomes following inpatient penicillin allergy testing: A systematic review and meta-analysis". Allergy. 72 (9): 1288–1296. doi: 10.1111/all.13168 . ISSN   1398-9995. PMID   28370003. S2CID   13757804.
  12. ↑ Blumenthal, Kimberly G.; Ryan, Erin E.; Li, Yu; Lee, Hang; Kuhlen, James L.; Shenoy, Erica S. (2018-01-18). "The Impact of a Reported Penicillin Allergy on Surgical Site Infection Risk". Clinical Infectious Diseases. 66 (3): 329–336. doi:10.1093/cid/cix794. ISSN   1537-6591. PMC   5850334 . PMID   29361015.
  13. ↑ Trubiano, Jason A.; Vogrin, Sara; Chua, Kyra Y. L.; Bourke, Jack; Yun, James; Douglas, Abby; Stone, Cosby A.; Yu, Roger; Groenendijk, Lauren; Holmes, Natasha E.; Phillips, Elizabeth J. (May 2020). "Development and Validation of a Penicillin Allergy Clinical Decision Rule". JAMA Internal Medicine. 180 (5): 745–752. doi:10.1001/jamainternmed.2020.0403. ISSN   2168-6106. PMC   7076536 . PMID   32176248.
  14. ↑ Rossi S, ed. (2006). Australian Medicines Handbook. Adelaide: Australian Medicines Handbook. ISBN   978-0-9757919-2-9.(subscription required)
  15. ↑ Ohlsson, Arne; Shah, Vibhuti S; Ohlsson, Arne (2014). "Intrapartum antibiotics for known maternal Group B streptococcal colonization". Cochrane Database of Systematic Reviews. 2016 (6): CD007467. doi:10.1002/14651858.CD007467.pub4. PMID   24915629. S2CID   205189572.
  16. ↑ Cooper, Chuck (9 January 2015). "Bioterrorism and Drug Preparedness - Safety of Long Term Therapy with Penicillin and Penicillin Derivatives". www.fda.gov. Center for Drug Evaluation. Retrieved 19 May 2017.
  17. ↑ Potter 2013, p. 897.
  18. ↑ Harrison, E. M.; Weinert, L. A.; Holden, M. T. G.; Welch, J. J.; Wilson, K.; Morgan, F. J. E.; Harris, S. R.; Loeffler, A.; Boag, A. K.; Peacock, S. J.; Paterson, G. K.; Waller, A. S.; Parkhill, J.; Holmes, M. A. (2014). "A Shared Population of Epidemic Methicillin-Resistant Staphylococcus aureus 15 Circulates in Humans and Companion Animals". mBio. 5 (3): e00985–13–e00985–13. doi:10.1128/mBio.00985-13. ISSN   2150-7511. PMC   4030480 . PMID   24825010.
  19. ↑ Briggs, Helen (22 May 2014). "MRSA: Hospital superbug 'shared with pets'". The British Broadcasting Company. Retrieved 20 May 2017– via www.bbc.com.
  20. ↑ "Three Things Every Dog Owner Should Know About Antibiotics - Dogs Naturally Magazine". 27 May 2013. Retrieved 19 May 2017.
  21. ↑ "The Dangers of Antibiotic Misuse and Your Dog - Whole Dog Journal". www.whole-dog-journal.com. 29 January 2004. Retrieved 19 May 2017.
  22. ↑ Costa, Marcio C; Stämpfli, Henry R; Arroyo, Luis G; Allen-Vercoe, Emma; Gomes, Roberta G; Weese, J (2015). "Changes in the equine fecal microbiota associated with the use of systemic antimicrobial drugs". BMC Veterinary Research. 11 (1): 19. doi: 10.1186/s12917-015-0335-7 . ISSN   1746-6148. PMC   4323147 . PMID   25644524.
  23. ↑ "What is the correct dosage of penicillin for dogs?". 4 August 2015. Retrieved 19 May 2017.
  24. ↑ Kaplan, Megan I.; Lee, Justine A.; Hovda, Lynn R.; Brutlag, Ahna (2011). "Adverse effects associated with inadvertent intravenous penicillin G procaine-penicillin G benzathine administration in two dogs and a cat". Journal of the American Veterinary Medical Association. 238 (4): 507–510. doi: 10.2460/javma.238.4.507 . ISSN   0003-1488. PMID   21320022.
  25. ↑ Li, Shunming; Huang, Jingya; Chen, Zhiyao; Guo, Dan; Yao, Zhenjiang; Ye, Xiaohua (2017). "Antibiotic Prevention for Maternal Group B Streptococcal Colonization on Neonatal GBS-Related Adverse Outcomes: A Meta-Analysis". Frontiers in Microbiology. 8: 374. doi: 10.3389/fmicb.2017.00374 . ISSN   1664-302X. PMC   5355432 . PMID   28367139.

Bibliography

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