Penicillin G

INTRODUCTION

Indications

Treatment of a wide variety of infections, including Pneumococcal pneumonia, Streptococcal pharyngitis, Syphilis, Gonorrhea strains. Treatment of enterococcal infections (requires the addition of an aminoglycoside). Prevention of rheumatic fever. Should not be used as a single agent to treat anthrax. Unlabeled Use: Treatment of Lyme disease, prevention of recurrent Streptococcal pneumoniae septicemia in children with sickle-cell disease.

Action

Bind to bacterial cell wall, resulting in cell death. Therapeutic Effects: Bactericidal action against susceptible bacteria. Spectrum: Active against Most gram-positive organisms, including many streptococci (Streptococcus pneumoniae, group A beta-hemolytic streptococci), staphylococci (non–penicillinase–producing strains), and Bacillus anthracis; Some gram-negative organisms, such as Neisseria meningitidis and N. gonorrhoeae (only penicillin-susceptible strains); Some anaerobic bacteria and spirochetes, including Borrelia burgdorferi.

Adverse Reactions/Side Effects

CNS: SEIZURES. GI: diarrhea, epigastric distress, nausea, vomiting, pseudomembranous colitis. GU: interstitial nephritis. Derm: rash, urticaria. Hemat: eosinophilia, leukopenia. Local: pain at IM site, phlebitis at IV site. Misc: ALLERGIC REACTIONS, INCLUDING ANAPHYLAXIS AND SERUM SICKNESS, superinfection.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Watch for seizures; notify physician immediately if patient develops or increases seizure activity.

• Monitor signs of allergic reactions and anaphylaxis, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough dyspnea) or skin reactions (rash, prurits, urticaria). Notify physician or nursing staff immediately if these reactions occur.

• Assess muscle aches and joint pain (arthralgia) that may be caused by serum sickness. Notify physician if these symptoms seem to be drug related rather than caused by musculoskeletal injury or if muscle and joint pain are accompanied by allergy-like reactions (fever, rashes, etc.)

• Monitor signs of eosinophilia (fatigue, weakness, myalgia) or leukopenia (fever, sore throat, signs of infection); report these signs to the physician.

• Monitor injection site for pain, swelling, and irritation. Report prolonged or excessive injection site reactions to the physician.

Interventions

• Always wash hands thoroughly and disinfect equipment (whirlpools, electrotherapeutic devices, treatment tables, and so forth) to help prevent the spread of infection. Use universal precautions or isolation procedures as indicated for specific patients.

Patient/Client-Related Instruction

• Instruct patient to notify physician immediately if signs of the following occur:

  • ∘ Pseudomembranous colitis (diarrhea, abdominal pain, fever, pus or mucus in stools) or other severe or prolonged GI problems (nausea, vomiting, heartburn).

  • ∘ Superinfection (black, furry overgrowth on tongue; vaginal itching or discharge; loose or foul-smelling stools).

  • ∘ Interstitial nephritis (blood in urine, decreased urine output, weight gain ...