*6.1.1.2.2 Procaine penicillin G*

After IM injection it is a slowly absorbed, water-insoluble crystal salt of penicillin G. It is used in pneumococcus, streptococcus and meningococcal infections. Newborn: 50.000 U/kg/day IM (single dose); the others 25-50.000 U/kg/day IM (single dose) (Dökmeci, 2000).

The Administration and Dose of Most Frequently Used Drugs in Pediatrics 305

This group of penicillin cannot hydrolyze with staphylococcal penicillinase. This antibiotic is preferred in staphylococcal infections resistant to penicillin (Eroğlu, 2002; Küçüködük,

For others: IV (15-30 min.), IM 100-200 mg/kg/day (every 4-6 hours), PO: 50-100

*Side effects*: It can cause interstitial nephritis. The dose should be adjusted in renal failure.

Even if administered with meals through GIS amoxicillin is absorbed faster and almost completely and has fewer side effects compared to ampicillin. It is an acid resistant ampicillin derivative and administered at a dose of PO; 25-50 mg/kg/day (every 8 hours)

In a study where Feder and his friends (1999) compared the effects of Amoxicillin and Penicillin V it has been found out that amoxicillin does better than penicillin V in the treatment of angina caused by group a beta-hemolytic streptococcus (Feder et al, 1999).

It covers the gram negative spectrum of penicillin. Newborn: IM, IV (15-30 min.), <7 days <2000 g: 50 mg/kg/day (every 12 hours), >2000 g: every 8 hours, >7 days <2000 g: 100

Infant, child: 50-100 mg/kg/day, PO (every 4-6 hours), Sepsis: 100-200 mg/kg/day IV (every 4 hours), Meningitis: 200-400 mg/kg/day IV (every 4 hours), in other infections: 100- 200 mg/kg/day IV (every 4-6 hours) (Eroglu, 2002; Dokmeci, 2000; Kucukoduk, 1994).

*Drugs to be confronted at the end point:* Fat emulsions, Acyclovir, Aminophylline, Calcium gluconate, Cefepime, Furosemide, Heparin, Insulin, Magnesium sulfate, Metronidazole,

*Incompatible Drugs:* Dex/Amino acid, Amicasin, Dopamine, Epinephrine, Fluconazole,

Along with other penicillin it can produce cross allergic reaction (Apak, 1996).

**6.1.2 Penicillines resistant to penicillinase enzyme** 

<2000g >14 days: 75 mg/kg/day (every 8 hours), >2000g <14 days: 75 mg/kg/day (every 8 hours), >2000g >14 days: 100 mg/kg/day (every 6 hours),

IM, IV (15-30min.), <2000g <14 days: 50 mg/kg/day (every 12 hours),

mg/kg/day (every 6 hours) (Eroğlu, 2002; Küçüködük 1994).

1994).

**6.1.2.1 Methicillin** 

**6.1.2.2 Aminopenicillin** 

*6.1.2.2.1 Amoxicillin* 

(Longo et al, 2002).

*6.1.2.2.2 Ampicillin* 

mg/kg/day, >2000 g: every 6 hours.

*Mode of Administration:* IV slow

Potassium chloride, Vancomycin.

Gentamicin, Midazolam, Sodium bicarbonate. *Storage Conditions:* Should be consumed in 1 hour.

*Miscible Serums:* 5% Dex, SF

*Preparation:* Vials are prepared with 5-10 ml sterile water.

In newborn,

*Side effects*: Allergy, shock (Apak, 1996).

*6.1.1.2.3 Benzathine penicillin G* 

It is a salt of penicillin G which establishes quite low serum levels, which is water-insoluble and whose effect however remains for 3-4 weeks. In rheumatic fever prophylaxis, 600.000- 1.200.000 U/dose IM (each month) is applied. Penadur LA, Deposilin are its derivatives. It does not cause shock (Apak, 1996; Dökmeci, 2000; Eroğlu, 2002).

*Monitoring*: Shall high doses be applied in patients with renal failure the serum sodium and potassium levels should be monitored. They should be monitored in terms of extravasation (Kanmaz, 2010).

*Caution:* The crystallized penicillin G should only be used IV. Procaine and benzathine penicillin G should only be used IM (Kanmaz, 2010).

*Incompatible Drugs:* Amphotericin B, aminophylline, aminoglycosides, metoclopramide (Kanmaz, 2010).

*The things to be considered by nurse applying the drug:* Nurse should know whether child is allergic to the drug or not (Kavakl et al, 1998).

After the vial is diluted with sterile water the drug should be well dissolved before the desired dose is taken from the vial.

In case that high dose of Penicillin G is rapidly administered by IV route it can cause such electrolyte imbalances as potassium and sodium. So the drug should be administered very slowly. When administered by IM route, the injection area should be carefully selected; the drug should be administered deep and the area should be frequently changed (Kavakl et al, 1998).

After the drug is administered by parenteral route the children should at least be monitored for an hour especially in terms of allergy and anaphylaxis. The presence of erythema and pallor in the injection area of IV and IM can be a sign of sensitivity. And also in case that the child is observed with anxiety, nausea, vomiting, dyspnea, tremor, instant febrility, and rash it should be considered that it might be an allergic reaction. Allergic reactions should immediately be notified to doctor. Drug, tools and equipment should all be available for an emergency (Kavakl et al, 1998).

In case of an extravasation hyaluronidase can be used (Kanmaz, 2010).

Toxicity symptoms should be closely monitored in newborns, infants and people with renal failure. Bleeding time should be monitored (Kavakl et al, 1998).

In oral route the best is to administer the drug with water pre-meals. Administering the drug 1 hour before, or 2 hours later than the meals decreases the effect of gastric acid or the possibility that foods delay the absorption of drugs. Child should be prevented from drinking acid beverages 1 hour before and after the administration of drug (Kavakl et al, 1998).

Tablet drugs should be protected against light. Oral suspensions and syrups should be preserved in refrigerator. The infusion solutions of penicillin G can stay for 24 hours under room temperature (Kavakl et al, 1998).
