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5.1.1 Penicillins

First line drugs Second line drugs Specialist drugs Secondary care drugs

Δ = For use only after consultation with the on-call Microbiologist during working hours, except in Critical Care, Cardiothoracic ICU, Oncology and Haematology and where treatment guidelines advise the use of the agent, eg. neutropenia, meningitis, etc. Outside of working hours, these agents can be used but the on-call Microbiologist may subsequently challenge the choice of these restricted antibiotics.

5.1.1.1 Benzylpenicillin and phenoxymethylpenicillin

(Low risk for C. difficile disease)

Benzylpenicillin

  • Injection 600mg, 1.2g

Phenoxymethylpenicillin

  • Tablets 250mg
  • Oral solutionSF 125mg/5ml, 250mg/5ml

Benzathine benzylpenicillin  

(Unlicensed)

  • Injection 2,400,00 units 

Note: Benzathine benzylpenicillin is included for the treatment of syphilis infection only.

5.1.1.2 Penicillinase-resistant pencillins

(Low risk for C. difficile disease) 

Flucloxacillin

  • Capsules 250mg, 500mg
  • Oral solution 125mg/5ml, 250mg/5ml
  • Injection 250mg, 500mg, 1g

CSM warning: Cholestatic jaundice may occur up to several weeks after treatment with flucloxacillin has been stopped. Administration for more than 2 weeks and increasing age are risk factors.

5.1.1.3 Broad-spectrum penicillins

(Moderate risk for C. difficile disease) 

Amoxicillin

  • Capsules 250mg, 500mg
  • Oral suspensionSF 125mg/1.25ml, 125mg/5ml, 250mg/5ml
  • Injection 250mg, 500mg, 1g

Co-amoxiclav

(Amoxycillin / clavulanic acid) 

  • Tablets 250/125, 500/125
  • Oral suspensionSF 125/31 5ml, 250/62 5 ml, 400/57 (Duo) 5ml
  • Injection 500/100, 1000/200

Notes:

  • Following the CSM warning Co-amoxiclav is only recommended as first line treatment in specific indications. The risk of acute liver toxicity is 6 times greater with co-amoxiclav than with amoxicillin. Cholestatic jaundice is more common in patients above the age of 65 and in males. The duration of treatment should not usually exceed 14 days.
  • It is advised that co-amoxiclav is avoided in pregnancy because of the association with an increased risk of necrotising entercolitis in the newborn. (ORACLE trials – Lancet March 2001)

5.1.1.4 Antipseudomonal penicillins

(Moderate risk for C. difficile disease)

Tazocin®   Δ

  • Injection piperacillin 2g / tazobactam 250mg
  • Injection piperacillin 4g / tazobactam 500mg

Timentin®

  • Injection ticarcillin 3g / clavulanic acid 200mg

5.1.1.5 Mecillinams

Pivmecillinam Δ

  • Tablets 200mg

Note: Pivmecillinam is for treatment of urinary tract infection only when cultures confirm sensitivity to pivmecillinam. The dose recommended by microbiology will be 400mg BD for 5 days which is outside of the licence but that there is evidence to suggest it to be superior. Pivmecillinam should not be used for second line empirical treatment.

Return to Chapter: 5. Infections

Last updated by: Carol Webb on 02-04-2013 08:47