Lpv

Lpv (Penicillin V) is narrow spectrum antibiotic used to treat mild to moderate infections caused by susceptible bacteria. It is a natural penicillin antibiotic that is administered orally. Penicillin V may also be used in some cases as prophylaxis against susceptible organisms. Natural penicillins are considered the drugs of choice for several infections caused by susceptible gram positive aerobic organisms, such as Streptococcus pneumoniae, groups A, B, C and G streptococci, nonenterococcal group D streptococci, viridans group streptococci, and non-penicillinase producing staphylococcus. Aminoglycosides may be added for synergy against group B streptococcus (S. agalactiae), S. viridans, and Enterococcus faecalis. The natural penicillins may also be used as first or second line agents against susceptible gram positive aerobic bacilli such as Bacillus anthracis, Corynebacterium diphtheriae, and Erysipelothrix rhusiopathiae. Natural penicillins have limited activity against gram negative organisms; however, they may be used in some cases to treat infections caused by Neisseria meningitidis and Pasteurella. They are not generally used to treat anaerobic infections. Resistance patterns, susceptibility and treatment guidelines vary across regions.

Penicillin V potassium tablets are indicated in the treatment of mild to moderately severe infections due to penicillin G-sensitive microorganisms. Therapy should be guided by bacteriological studies (including sensitivity tests) and by clinical response.

NOTE: Severe pneumonia, empyema, bacteremia, pericarditis, meningitis, and arthritis should not be treated with penicillin V during the acute stage. Indicated surgical procedures should be performed.

The following infections will usually respond to adequate dosage of penicillin V.

Streptococcal Infections (without bacteremia)

Mild-to-moderate infections of the upper respiratory tract, scarlet fever, and mild erysipelas.

NOTE: Streptococci in groups A, C, G, H, L, and M are very sensitive to penicillin. Other groups, including group D (enterococcus), are resistant.

Pneumococcal Infections

Mild to moderately severe infections of the respiratory tract.

Staphylococcal infections – penicillin G-sensitive

Mild infections of the skin and soft tissues.

NOTE: Reports indicate an increasing number of strains of staphylococci resistant to penicillin G, emphasizing the need for culture and sensitivity studies in treating suspected staphylococcal infections.

Fusospirochetosis (Vincent’s gingivitis and pharyngitis )

Mild to moderately severe infections of the oropharynx usually respond to therapy with oral penicillin.

NOTE: Necessary dental care should be accomplished in infections involving the gum tissue.

Medical conditions in which oral penicillin therapy is indicated as prophylaxis: For the prevention of recurrence following rheumatic fever and/or chorea: Prophylaxis with oral penicillin on a continuing basis has proven effective in preventing recurrence of these conditions.

Although no controlled clinical efficacy studies have been conducted, penicillin V has been suggested by the American Heart Association and the American Dental Association for use as an oral regimen for prophylaxis against bacterial endocarditis in patients who have congenital heart disease or rheumatic or other acquired valvular heart disease when they undergo dental procedures and surgical procedures of the upper respiratory tract.

To reduce the development of drug-resistant bacteria and maintain the effectiveness of penicillin-VK and other antibacterial drugs, penicillin-VK should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria. When culture and susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy. In the absence of such data, local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy.

Adults: 250-500 mg every 6 hrs.

Children: Suggested dosage for infants and children is 50 mg/kg body weight/day in 4 divided doses. To be given every 6 hrs.

Children 7-12 years: 5-10 mL (1-2 tsp) of Lpv 250 mg/5 mL; 3-6 years: 5-10 mL (1-2 tsp) of Lpv 125 mg/5 mL or 5 mL (1 tsp) of Lpv 250 mg/5 mL; 1-2 years: 5 mL (1 tsp) of Lpv 125 mg/5 mL or 2.5-5 mL of Lpv 250 mg/5 mL.

Usual duration of therapy is from 10-14 days. Or as prescribed by the physician.

Lpv should not be given to patients known to be allergic to penicillin and should be given with care to patients with a history of allergy to cephalosporins. Cases of cross sensitivity have been reported. It should not be given to babies, in the neonatal period, born of hypersensitive mothers. It is not recommended for chronic, severe or deep-seated infections such as subacute bacterial endocarditis, meningitis or syphilis.

Lpv should not be combined with bacteriostatic antibiotics. Combinations with other antibiotics should be considered if their effects can be expected to be synergistic or at least additive. The combination partners should be fully dosed. (Exception: In combination with a proven synergistic action, the dose of the more toxic combination partner may be reduced.) Competitive inhibition of drug elimination should be remembered, whenever anti-inflammatories, antirheumatics, antipyretics (particularly indomethacin, phenylbutazone, salicylates in high doses) or probenecid are used concomitantly. Ingestion of Lpv with meals reduce the absorption of the drug. Like other antibiotics, Lpv may reduce the efficacy of oral contraceptives. During treatment with Lpv non-enzymatic urinary glucose tests and uribilinogen tests may be false-positive. Urinary amino acid quantitations with ninhydrin may also be false-positive.

Applies to penicillin v potassium: capsule, powder for solution, powder for suspension, solution, suspension, syrup, tablet, tablet for suspension, tablet chewable, tablet extended release

As well as its needed effects, penicillin v potassium (the active ingredient contained in Lpv) may cause unwanted side effects that require medical attention.

Stop taking penicillin v potassium and get emergency help immediately if any of the following effects occur:

Less common:

• Fast or irregular breathing
• fever
• joint pain
• lightheadedness or fainting (sudden)
• puffiness or swelling around the face
• red, scaly skin
• shortness of breath
• skin rash, hives, itching

Major Side Effects

If any of the following side effects occur while taking penicillin v potassium, check with your doctor immediately:

Rare

• Abdominal or stomach cramps and pain (severe)
• abdominal tenderness
• convulsions (seizures)
• decreased amount of urine
• diarrhea (watery and severe), which may also be bloody
• mental depression
• nausea and vomiting
• pain at place of injection
• sore throat and fever
• unusual bleeding or bruising
• yellow eyes or skin

• Agitation or combativeness
• anxiety
• confusion
• fear of impending death
• feeling, hearing, or seeing things that are not real

Minor Side Effects

Some penicillin v potassium side effects may not need any medical attention. As your body gets used to the medicine these side effects may disappear. Your health care professional may be able to help you prevent or reduce these side effects, but do check with them if any of the following side effects continue, or if you are concerned about them:

More common:

• Diarrhea (mild)
• headache
• sore mouth or tongue
• vaginal itching and discharge
• white patches in the mouth and/or on the tongue