Side effects of penicillin
The side effects of penicillin are bodily responses to
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
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":
- PENicillin allergy reported (start assessment)
- Five years ago or less (2 points)
- Anaphylaxis occurred (2 points)
- Severe cutaneous adverse reaction such as SJS occurred (2 points)
- Treatment was required (1 point)
Patients scoring 4 or greater have a high (50%) probability of testing positive for penicillin allergy.[13]
Side effects in adults
Common
Very common (>10% incidence)
- diarrhea
- epigastric distress
- nausea
- vomiting
- pseudomembranous colitis
- interstitial nephritis
- rash
- urticaria(hives)
- eosinophilia
- leukopenia (decrease in white blood cells)
- allergic reactions
- superinfection[10]
Common (1-10% incidence)
- yeast infection
- lack of therapeutic effect[15]
- vaginal itching
- vaginal discharge
- white patches in the mouth and tongue[4]
Uncommon (<1%)
- wheezing[10]
- fever
- joint pain
- lightheadedness
- fainting
- facial edema (puffiness of the face)
- red, scaly skin
- shortness of breath
- skin rash, hives
- irregular breathing[4]
Life threatening
- anaphylaxis
- serum sickness
- seizures
- laryngeal edema[10]
Rare (<0.1%)
- tooth discoloration
- erythema multiforme
- vertigo
- decreased platelet count
- tinnitus
- convulsions
- hypertonia
- cardiac arrest
- cyanosis
- palpitations
- chest pain
- macular rash[16]
- yellow eyes or skin
- stomach or abdominal cramps
- severe abdominal pain
- bloody diarrhea
- depression
- decreased urine excretion
- sore throat
- bleeding or bruising
- agitation
- combativeness
- anxiety
- confusion
- hallucinations[4]
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]
References
- ^ "Definitions" (PDF). The World health organization. Retrieved May 20, 2017.
- ^ Vallerand 2017, pp. 3–4.
- ^ Karch 2017, p. 115.
- ^ a b c d "Penicillin (Oral Route, Injection Route, Intravenous Route, Intramuscular Route) Side Effects - Mayo Clinic". www.mayoclinic.org. Retrieved 18 May 2017.
- ^ "Penicillin use during pregnancy not linked to birth defects". 16 December 2009. Retrieved 19 May 2017.
- S2CID 246149945. Retrieved 2022-06-24.
- PMID 34116641.
- ^ S2CID 6717270.
- ^ "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.
- ^ a b c d e f Vallerand 2017, pp. 989–994.
- S2CID 13757804.
- PMID 29361015.
- PMID 32176248.
- ISBN 978-0-9757919-2-9. (subscription required)
- S2CID 205189572.
- ^ 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.
- ^ Potter 2013, p. 897.
- PMID 24825010.
- ^ Briggs, Helen (22 May 2014). "MRSA: Hospital superbug 'shared with pets'". The British Broadcasting Company. Retrieved 20 May 2017 – via www.bbc.com.
- ^ "Three Things Every Dog Owner Should Know About Antibiotics - Dogs Naturally Magazine". 27 May 2013. Retrieved 19 May 2017.
- ^ "The Dangers of Antibiotic Misuse and Your Dog - Whole Dog Journal". www.whole-dog-journal.com. 29 January 2004. Retrieved 19 May 2017.
- PMID 25644524.
- ^ "What is the correct dosage of penicillin for dogs?". 4 August 2015. Retrieved 19 May 2017.
- PMID 21320022.
- PMID 28367139.
Bibliography
- Henry, Norma (2016). RN nursing care of children : review module. Stilwell, KS: Assessment Technologies Institute. ISBN 9781565335714.
- Karch, Amy (2017). Focus on nursing pharmacology. Philadelphia: Wolters Kluwer. ISBN 9781496318213.
- Potter, Patricia (2013). Fundamentals of nursing. St. Louis, Mo: Mosby Elsevier. ISBN 9780323079334.
- Vallerand, April (2017). Davis's drug guide for nurses. Philadelphia: F.A. Davis Company. ISBN 9780803657052.
External links
