Penicillin V potassium is an orally available antibiotic. It has a very narrow spectrum of antibacterial properties and is used to treat mild to moderate infections.

Indications of Penicillin V potassium

• Fusospirochetosis (Vincent gingivitis and pharyngitis):

  • It used for treating fusospirochetosis (Vincent gingivitis and pharyngitis) in addition to dental hygiene.

• Pneumococcal infections:

  • Mild to moderately severe pneumococcal respiratory tract infections, including otitis media can be treated with penicillin V potassium.

• Rheumatic fever and/or chorea prophylaxis:

  • It is used for prophylaxis (chronic, secondary) of rheumatic fever and/or chorea.

• Penicillin G-sensitive Staphylococcal infections:

  • It is prescribed for the treatment of mild infections of the skin and soft tissues.

• Streptococcal infections without bacteremia:

  • Management of mild to moderate streptococcal infections of the upper respiratory tract, scarlet fever, and mild erysipelas is done by penicillin V potassium.

• Off Label Use of Penicillin V potassium in Adults:

  • Actinomycosis;
  • Bite wounds (animal);
  • Chronic antimicrobial suppression of prosthetic joint infection;
  • Cutaneous anthrax;
  • Cutaneous erysipeloid;
  • Pneumococcal prophylaxis in hematopoietic cell transplant;
  • Chronic Streptococcus group A carrier

Penicillin V dosage in adults:

Usual dosage range:

• 125 to 500 mg per oral every 6 to 8 hours.

Penicillin V Dose in the treatment of Actinomycosis:

Note:

The duration depends on the disease location and patient-specific factors.

• 2 to 4 g/day in per-oral in divided doses (every 6 hours).

Penicillin V dose in the treatment of Animal Bite Wounds:

• 500 mg per oral q.i.d daily in combination with dicloxacillin.

Penicillin V dose in the treatment of community-acquired Cutaneous anthrax:

• 500 mg per oral q.i.d daily for 7 to 10 days.

Dose in the treatment of Cutaneous erysipeloid:

• 500 mg per oral q.i.d daily for 7 to 10 days.

Penicillin V dose in the treatment of Erysipelas:

• 500 mg per oral q.i.d daily.

• Manufacturer's labeling:

  • Dosing in the prescribing information may not reflect current clinical practice.
  • 125 to 250 mg every 6 to 8 hours.

Dose in the treatment of Fusospirochetosis (Vincent infection):

• 250 to 500 mg per oral every 6 to 8 hours.

Dose for Pneumococcal prophylaxis in hematopoietic cell transplant:

• 250 to 500 mg per oral b.i.d daily.
• Note: Use only in areas where the incidence of penicillin-resistant S. pneumoniae is low.

Penicillin V dose in the treatment dose of Prosthetic joint infection:

• Chronic oral antimicrobial suppression (Enterococcus spp [penicillin-susceptible], streptococci [beta-hemolytic], Cutibacterium spp):

  • 500 mg per oral b.i.d or q.i.d daily.

Penicillin V dose in the treatment of Streptococcal skin infection:

• 250 to 500 mg per oral every 6 hours.

Penicillin V dose in the treatment of Group A Streptococcal infections: 

• Acute treatment of Pharyngitis:

  • 500 mg per oral b.i.d or ti.d daily for 10 days or 250 mg 4 times daily or 500 mg twice daily for 10 days.

• Secondary prophylaxis for rheumatic fever (prevention of recurrent attacks):

  • 250 mg per oral b.i.d daily. Duration depends on risk factors and the presence of valvular disease.

• Chronic carriage:

  • 500 mg per oral q.i.d daily for 10 days in combination with oral rifampin.
  • Note: Most individuals with chronic carriage do not require antibiotics.

Penicillin V potassium dose in children:

Penicillin V General dosing in susceptible infections:

• Infants and Children <12 years:

  • Mild to moderate infection:

    • 25 to 75 mg/kg/day per oral in divided doses every 6 to 8 hours.
    • The maximum daily dose is 2,000 mg/day.

• Children ≥12 years and Adolescents:

  • Manufacturer's labeling (fixed dosing):

    • 125 to 500 mg per oral every 6 to 8 hours.

  • Alternate dosing (weight-based):

    • Mild to moderate infection: 25 to 75 mg/kg/day per oral in divided doses every 6 to 8 hours.
    • maximum daily dose: 2,000 mg/day.

Penicillin V dose for the treatment of community-acquired cutaneous Anthrax:

• Infants, Children, and Adolescents:

  • 25 to 50 mg/kg/day per oral in divided doses 2 or 4 times daily.
  • The maximum single dose: 500 mg.

Penicillin V dose in the treatment of mild to moderately severe Fusospirochetosis infections (Vincent infection):

• Children ≥12 years and Adolescents:

  • 250 to 500 mg per oral every 6 to 8 hours.

Penicillin V dose in the treatment of Tonsillopharyngitis caused by Group A streptococcal infection and for the treatment and primary prevention of Rheumatic fever:

• Acute treatment :

  • Children ≤27 kg:

    • 250 mg per oral twice or thrice daily for 10 days.
  • Children >27 kg and Adolescents:
    • 500 mg per oral 2 to 3 times daily for 10 days; in adolescents, 250 mg 4 times daily has also been suggested.

• Chronic carrier treatment (Group A streptococci):

  • Children and Adolescents:

    • 50 mg/kg/day per oral in 4 divided doses for 10 days in combination with oral rifampin.
    • maximum daily dose: 2,000 mg/day.

Penicillin V dose for the prophylaxis of Recurrent rheumatic fever:

• Children and Adolescents:

  • 250 mg per oral b.i.d daily.

Penicillin V dose for the prophylaxis of Pneumococcal infection in patients with anatomic or functional asplenia (such as sickle cell disease):

• Infants (as soon as SCD diagnosed or asplenic) and Children <3 years:

  • 125 mg per oral b.i.d daily.

• Children ≥3 years:

  • 250 mg per oral b.i.d daily; the decision to discontinue penicillin prophylaxis after 5 years of age in children who have not experienced invasive pneumococcal infection and have received recommended pneumococcal immunizations is patient and clinician dependent

Penicillin V dose for the treatment of mild community-acquired Pneumonia or as a stepdown therapy caused by Group A Streptococcus

• Infants ≥3 months, Children, and Adolescents:

  • 50 to 75 mg/kg/day per oral in 3 to 4 divided doses.
  • The maximum daily dose is 2,000 mg/day.

Pregnancy Risk Category: B

• Penicillin can cross the placenta.
• There has not been any increase in the risk of adverse fetal consequences due to maternal use.
• For the treatment of Bacillus Anthracis in pregnant women, alternate agents should be used.

Penicillin V potassium use during breastfeeding:

• Breast milk is where the drug is excreted.
• The relative infant dose (RID), is 0.6%. It is calculated by using the highest concentration of breast milk and compared with a weight-adjusted maternal daily dosage of 2,640m.
• When the RID is less than 10, breastfeeding is acceptable.
• Breast milk has a daily intake of 0.23 mg/kg/day. This is assuming that the highest concentration of milk (1.55mg/l) is used.
• The peak milk concentration reached at 2-8 hours after receiving a 1,320mg dose. Breast milk half-life ranged between 1 and 3.8 hours for women with mastitis.
• Some infants who breastfeed may have it in their urine.
• Breastfeeding infants can experience rash and diarrhea after being exposed to the drug.
• Monitoring for GI disturbances is therefore essential.
• Breastfeeding is possible for mothers who are undergoing treatment.

Dose adjustment in renal disease:

There are no dosage adjustments provided in manufacturer’s labeling. Use with caution as excretion is prolonged in patients with renal impairment.

Dose adjustment in liver disease:

There are no dosage adjustments provided in manufacturer’s labeling.

Side Effects of Penicillin V potassium:

• Gastrointestinal:

  • Melanoglossia
  • Mild Diarrhea
  • Nausea
  • Oral Candidiasis
  • Vomiting

Contraindication to Penicillin V potassium:

• Hypersensitivity to penicillin and any component of the formulation

Warnings and precautions

• Anaphylactic and hypersensitivity reactions

  • Hypersensitivity reactions that can lead to severe and fatal hypersensitivity reactions are more common in those who have a history either of beta-lactam hypersensitivity, or multiple allergen sensitivity.
  • Asthmatic patients should not use it.
  • Anaphylaxis requires immediate airway protection and supportive management.

• Superinfection

  • Long-term therapy can be used to treat fungal or bacterial superinfections, such as pseudomembranous and C. difficile-associated diarrhea.

• Renal impairment

  • Patients with severe renal impairment should be cautious.

• Seizure disorders:

  • Higher doses of treatment are more likely to cause seizures in patients with renal impairment.

Penicillin V potassium (oral): Drug Interaction

Monitoring Parameters:

Hematologic function tests Renal function tests Monitor for signs of anaphylaxis during first dose

How to administer Penicillin V potassium?

It is given orally around-the-clock to promote less variation in peak and trough serum levels on an empty stomach 1 hour before or 2 hours after meals, to enhance absorption.

Mechanism of action of Penicillin V potassium:

• Penicillin V potassium is a penicillin-binding protein (PBP) that inhibits the final transpeptidation step in peptidoglycan synthesis in bacterial cell walls. This causes inhibition of cell wall biosynthesis.
• It also reduces cell wall assembly and bacterial lysis due to the activity of cell-wall autolytic enzymes (autolysins or murein hydrolases).

Protein binding in the plasma is 80%

Excretion: Urine (as unchanged drug and metabolites)

International Brands of Penicillin V potassium:

• APO-Pen VK
• NOVO-Pen-VK [DSC]
• Pen-VK
• Anapenil
• Apocillin
• Beapen VK
• Cilicaine VK
• Fenocin
• Kaypen
• P.V.
• Len V.K.
• Megacilina Oral
• Milcopen
• Oracillin VK
• Orapen
• Orvek
• Ospa-V
• Ospen
• P.V.
• Pen V
• Pen Ve Oral
• Pen-Vi-K
• Penilevel
• Penoxil
• Pota-Vi-Kin
• Prevecilina
• Robicillin VK
• Semicillin
• Sumapen
• V-Cil-K
• V-Cillin K
• Vikadar
• Weifapenin

Penicillin V potassium Brands in Pakistan: