Explore chapters and articles related to this topic
Antibiotics: The Need for Innovation
Published in Nathan Keighley, Miraculous Medicines and the Chemistry of Drug Design, 2020
The properties of penicillin G make it a good choice to use as an antibiotic medicine. It is active against non-β-lactamase producing (in other words non-resistant) gram-positive bacteria, such as meningitis, gonorrhoea and several gram-negative cocci and anaerobic microorganisms, such as Streptococcus and Enterococcus,so is active against many rapidly dividing types of bacteria. Penicillin is non-toxic and very safe (magic bullet), however, some people have allergies to penicillin. Allergies range from a mild rash to anaphylactic shock. Small molecules such as penicillin generally do not cause this effect, but nucleophilic groups on proteins will react with the open β-lactam ring and therefore becomes covalently bonded to the protein, causing an immune response as the protein is ‘recognised’ as foreign. This only happens in 0.2% of patients. Other limitations to penicillin G is poor activity against gram-negative bacteria, so does not have a broad spectrum of activity. The molecule is broken down by stomach acid, so cannot be taken orally and must be injected, which is the least favourable route of administration to patients. To overcome some of these limitations, it was necessary to synthesis penicillin analogues. These compounds must retain the essential aspects of the molecule crucial to the mechanism of action, while possessing structural modifications that will change the interaction of the drug with the body in such a way as to overcome the limitations of the drug.
Bacillus
Published in Dongyou Liu, Handbook of Foodborne Diseases, 2018
B. anthracis is sensitive to penicillin, gentamicin, imipenem, and vancomycin, although some B. anthracis strains are resistant to amoxicillin (40%), cefazolin (55%), ceftriaxone (40%), ciprofloxacin (41%), clindamycin (20%), and penicillin (100%). Cutaneous anthrax is readily treated, but gastrointestinal and pulmonary anthrax are often identified too late for treatment to be effective. Usually, 500 mg of penicillin V is given orally every 6 hours for 5 days, or 600 mg (1 million units) of procaine penicillin administered intramuscularly every 12–24 hours for 5 days in uncomplicated cases. Then 1200 mg (2 million units) of penicillin G is administered intravenously every 6 hours, reverting to the intramuscular regime of 600 mg every 12–24 hours once recovery starts in severe cases. Continuous-drip administration is advisable in pulmonary anthrax. Patients showing penicillin hypersensitivity may be treated with tetracyclines, chloramphenicol, gentamicin, or erythromycin [1,41].
Disaster surgery
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
Local wound care. This includes a thorough wound debridement to eliminate the anaerobic environment. Intravenous administration of 10-24 x 106 U per day of penicillin G should be continued for 10-14 days. The wound should be closed using the delayed primary or secondary closure techniques.
ALSUntangled #65: glucocorticoid corticosteroids
Published in Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration, 2023
Jill Ann Goslinga, Mark Terrelonge, Richard Bedlack, Paul Barkhaus, Benjamin Barnes, Tulio Bertorini, Mark Bromberg, Gregory Carter, Amy Chen, Jesse Crayle, Mazen Dimachkie, Leanne Jiang, Gleb Levitsky, Isaac Lund, Sarah Martin, Christopher Mcdermott, Gary Pattee, Kaitlyn Pierce, Dylan Ratner, Lenka Slachtova, Yuyao Sun, Paul Wicks
Lastly, three Caucasian males with ALS who were admitted to the hospital for progressive dysphagia and dysarthria were treated with a 21-day course of 1–20 million units of penicillin G and 100 mg of hydrocortisone (26). One patient who was previously wheelchair-bound could reportedly walk 100 meters one week after initiation of therapy, followed by improved speech and swallowing function and dexterity in his fingers. However, he was wheelchair-bound again by week 12; he received a second 21-day course of this therapy at week 13 and maintained functional speech and swallowing through 21 weeks of follow-up. Patients 2 and 3 noted improvements in speech, swallowing and muscle coordination within one week of treatment initiation and remained stable for 16+ weeks. It is not clear whether penicillin G, hydrocortisone, or both contributed to the observed effects. Limitations of this case series include possibility of concurrent syphilis or another infection treated by penicillin G (26). For a more critical look at this paper, please refer to our previous ALSUntangled review: Penicillin-G-hydrocortisone (27).
Ocular Syphilis: Experience over 11 Years at a German Ophthalmology Reference Centre
Published in Ocular Immunology and Inflammation, 2023
R. Yaici, A. Balasiu, C.R. MacKenzie, M. Roth, K. Beseoglu, C. Holtmann, G. Geerling, R. Guthoff
26/32 patients (81.3%) received systemic syphilis therapy. Penicillin G (3x10 Mio. U i.v daily for 21 days) was administered to nine patients (28.1%) and Benzathine penicillin G (2.4 Mio. U i.m) to four (12.5%) patients. Due to a suspected penicillin allergy, eight patients (25%) received ceftriaxone 2 g i.v daily for 14 days. Three patients (9.4%) received sequential therapy with penicillin G (3x10 Mio. U daily) for 21 days followed by ceftriaxone (2 g daily) for 14 days due to the lack of clinical improvement. One was treated with clindamycin 300 mg orally four times daily, for clinically suspected ocular toxoplasmosis, and one was treated with ceftriaxone 2 g/d and vancomycin 2 g i.v for suspected bacterial endophthalmitis. Seven patients (21.9%) received prednisolone to prevent a Jarisch-Herxheimer reaction (1 mg/kg body weight). 6/12 cases of Syphilis satis curata were treated locally with mydriatic drugs and prednisolone acetate 1%. The main side effect was Jarisch-Herxheimer reaction, followed by penicillin allergy and steroid-induced folliculitis.
Vasculitis in a case of rupioid syphilis in HIV
Published in Baylor University Medical Center Proceedings, 2022
Connor Rodriguez, Parneet Dhaliwal, Allison Readinger
Aspiration of the left knee was initially concerning for infection, and the patient was started on empiric antibiotics, but routine cultures were later determined to be negative. Dermatology was consulted and performed a punch biopsy of the skin. Histology demonstrated an abscess with medium- to large-sized blood vessels with fibrinoid necrosis of the vessel wall and neutrophilic infiltrate in and around the vessel walls (Figure 1b). Grocott methenamine silver, acid-fast bacilli, and Gram stains were negative for organisms as well as spirochete immunostain and human herpesvirus-8, likely due to treatment with empiric antibiotics. After communication between the clinician and the pathologist, with review of clinical lesions and pathologic findings, serologic testing was performed, showing a positive rapid plasma reagin (RPR) (1:128 titer), consistent with syphilis. The patient was started on intravenous benzathine penicillin G. He was continued on penicillin at his 4-week follow-up visit. The patient’s lesions resolved the next month with no recurrence.