Side effects of penicillin

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The side effects of penicillin are bodily responses to penicillin and closely related antibiotics that do not relate directly to its effect on bacteria. A side effect is an effect that is not intended with normal dosaging.[1] Some of these reactions are visible and some occur in the body's organs or blood. Penicillins are a widely used group of medications that are effective for the treatment of a wide variety of bacterial infections in human adults and children as well as other species. Some side effects are predictable, of which some are common but not serious, some are uncommon and serious and others are rare.[2] The route of administration of penicillin can have an effect on the development of side effects. An example of this is irritation and inflammation that develops at a peripheral infusion site when penicillin is administered intravenously. In addition, penicillin is available in different forms. There are different penicillin medications (penicillin G benzathine, penicillin G potassium, penicillin G procaine, and penicillin V)[3] as well as a number of β-lactam antibiotics derived from penicillin (e.g. amoxicillin) generally also referred to as "penicillin".

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[edit]

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. 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).[6]

There is a common side effect that can develop when other medications are used. This is the development of cross sensitivities to other antibiotics. If someone has developed side effects when taking penicillin, these side effects may develop with a new medication even though the person has not taken the new medication before. Those medications that may cause a cross sensitivity reaction are: carbapenems, ampicillin, cefazolin, cephalosporins and cloxacillin.[7][6][8]

Side effects in adults[edit]

Common adverse drug reactions (≥ 1% of people) associated with use of the penicillins include diarrhoea, hypersensitivity, nausea, rash, neurotoxicity, urticaria, and superinfection (including candidiasis). Infrequent adverse effects (0.1–1% of people) include fever, vomiting, erythema, dermatitis, angioedema, seizures (especially in people with epilepsy), and pseudomembranous colitis.[9][subscription required][outdated?]

Very Common (>10% incidence)[edit]

Common (1-10% incidence)[edit]

  • vaginal itching
  • vaginal discharge
  • white patches in the mouth and tongue[4]

Uncommon (<1%)[edit]

Life threatening[edit]

Rare (<0.1%)[edit]

  • tooth discoloration
  • erythema multiforme
  • vertigo
  • decreased platelet count
  • tinnitus
  • convulsions
  • hypertonia
  • cardiac arrest
  • cyanosis
  • palpitations
  • chest pain
  • macular rash[12]
  • yellow eyes or skin
  • stomach or abdominal cramps
  • severe abdominal pain
  • bloody diarrhea
  • depression
  • decreased in urine excretion
  • sore throat
  • bleeding or bruising
  • agitation
  • combativeness
  • anxiety
  • confusion
  • hallucinations[4]

High doses[edit]

When penicillin is used at high doses hypokalemia, metabolic acidosis, and hyperkalemia can occur.[13] Developing hypernatremia after administering high doses of penicillin can be a serious side effect.[8]

Side effects from other medications[edit]

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 increase resulting in higher blood levels of penicillin in the circulation. In some instances, this would be 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 methotrexante.[8]

In animals[edit]

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.[14] [15] Nutritional deficiencies can develop in pets as a side effect.[16] Destruction of the normal protective flora of beneficial bacteria can occur in dogs and horses.[17][18] Dogs may have side effects that include: pain in their joints, loss of appetite, vomiting, flatulence (instestinal gas), fungal infections and digestive problems.[19][20] Like humans, dogs can have a similar side effect related to developing a serioys allergy. A serious and possibly fatal anaphylactic can occur. Side effects that are concurrent with anaphylaxis include: breathing problems and shock.[20]

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.[21]

Other side effects[edit]

Penicillin is known to become less effective as strains of bacteria become resistant.[22]


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  2. ^ Valerand, pp. 3-4.
  3. ^ Karch, p. 115.
  4. ^ a b c d "Penicillin (Oral Route, Injection Route, Intravenous Route, Intramuscular Route) Side Effects - Mayo Clinic". Retrieved 18 May 2017. 
  5. ^ "Penicillin use during pregnancy not linked to birth defects". 16 December 2009. Retrieved 19 May 2017. 
  6. ^ a b Gonzalez-Estrada, A.; Radojicic, C. (2015). "Penicillin allergy: A practical guide for clinicians". Cleveland Clinic Journal of Medicine. 82 (5): 295–300. doi:10.3949/ccjm.82a.14111. ISSN 0891-1150. 
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  8. ^ a b c Vallerand, pp. 989-994.
  9. ^ Rossi S, ed. (2006). Australian Medicines Handbook. Adelaide: Australian Medicines Handbook. ISBN 0-9757919-2-3. 
  10. ^ a b c Valerand, pp. 989-994.
  11. ^ Ohlsson, Arne; Shah, Vibhuti S; Ohlsson, Arne (2014). "Intrapartum antibiotics for known maternal Group B streptococcal colonization". doi:10.1002/14651858.CD007467.pub4. 
  12. ^ Cooper, Chuck (9 January 2015). "Bioterrorism and Drug Preparedness - Safety of Long Term Therapy with Penicillin and Penicillin Derivatives". Center for Drug Evaluation. Retrieved 19 May 2017. 
  13. ^ Potter, p. 897.
  14. ^ Harrison, E. M.; Weinert, L. A.; Holden, M. T. G.; Welch, J. J.; Wilson, K.; Morgan, F. J. E.; Harris, S. R.; Loeffler, A.; Boag, A. K.; Peacock, S. J.; Paterson, G. K.; Waller, A. S.; Parkhill, J.; Holmes, M. A. (2014). "A Shared Population of Epidemic Methicillin-Resistant Staphylococcus aureus 15 Circulates in Humans and Companion Animals". mBio. 5 (3): e00985–13–e00985–13. doi:10.1128/mBio.00985-13. ISSN 2150-7511. 
  15. ^ Briggs, Helen (22 May 2014). "MRSA: Hospital superbug 'shared with pets'". The British Broadcasting Company. Retrieved 20 May 2017 – via 
  16. ^ "Three Things Every Dog Owner Should Know About Antibiotics - Dogs Naturally Magazine". 27 May 2013. Retrieved 19 May 2017. 
  17. ^ "The Dangers of Antibiotic Misuse and Your Dog - Whole Dog Journal". Retrieved 19 May 2017. 
  18. ^ Costa, Marcio C; Stämpfli, Henry R; Arroyo, Luis G; Allen-Vercoe, Emma; Gomes, Roberta G; Weese, J (2015). "Changes in the equine fecal microbiota associated with the use of systemic antimicrobial drugs". BMC Veterinary Research. 11 (1): 19. doi:10.1186/s12917-015-0335-7. ISSN 1746-6148. 
  19. ^ "What is the correct dosage of penicillin for dogs?". Retrieved 19 May 2017. 
  20. ^ a b "Side Effects of Penicillin for Dogs". 
  21. ^ Kaplan, Megan I.; Lee, Justine A.; Hovda, Lynn R.; Brutlag, Ahna (2011). "Adverse effects associated with inadvertent intravenous penicillin G procaine-penicillin G benzathine administration in two dogs and a cat". Journal of the American Veterinary Medical Association. 238 (4): 507–510. doi:10.2460/javma.238.4.507. ISSN 0003-1488. 
  22. ^ Li, Shunming; Huang, Jingya; Chen, Zhiyao; Guo, Dan; Yao, Zhenjiang; Ye, Xiaohua (2017). "Antibiotic Prevention for Maternal Group B Streptococcal Colonization on Neonatal GBS-Related Adverse Outcomes: A Meta-Analysis". Frontiers in Microbiology. 8. doi:10.3389/fmicb.2017.00374. ISSN 1664-302X. 


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