ISPN Review PENICILLINS AND PENICILLINASE RESISTANT ANTIBIOTICS 青霉素类和青霉素酶耐药性抗生素
Penicillin was the first antibiotic introduced for clinical use. Sir Alexander Fleming used Penicillium molds to produce the original penicillin in the 1920s. Subsequent versions of penicillin were developed to decrease the adverse effects of the drug and to modify it to act on resistant bacteria.
青霉素是是用于临床的首款抗生素。20世纪20年代，弗莱明使用青霉菌生产出了最初的青霉素。此后，青霉素不断发展，药物不利效应下降，经过改良，已经可用于耐药菌治疗。
Penicillins include penicillin G benzathine (Bicillin, Permapen), penicillin G potassium (Pfizerpen), penicillin G procaine (Crysticillin-AS), penicillin V (Veetids), amoxicillin (Amoxil, Trimox), ampicillin (Principen), and ticarcillin (Ticar).
青霉素包括苄星青霉素G（比西林、苄星青霉素制剂）、青霉素G钾（Pfizerpen）、普鲁卡因青霉素G（Crysticillin-AS）、青霉素V（青霉素V钾）、阿莫西林（奥纳欣、Trimox）、氨苄西林（Principen）和替卡西林（铁卡）。
With the prolonged use of penicillin, more and more bacterial species have synthesized the enzyme penicillinase to counteract the effects of penicillin. Researchers have developed a group of drugs with a resistance to penicillinase, which allows them to remain effective against bacteria that are now resistant to the penicillins. Penicillin-resistant antibiotics include nafcillin and oxacillin. The actual drug chosen depends on the sensitivity of the bacteria causing the infection, the desired and available routes, and the personal experience of the clinician with the particular agent.
长期使用青霉素，越来越多的细菌合成青霉素酶，抵抗青霉素的效应。研究人员已经研发出耐受青霉素酶的药物，这些药物可以保持对青霉素耐药菌的效应。青霉素耐药性抗生素包括萘夫西林和恶洒西林。选择哪种药物取决于感染菌敏感性、预期及可用的途径、临床医师对特殊药物的个人经验等。 Therapeutic Actions and Indications 治疗作用和适应症
The penicillins and penicillinase-resistant antibiotics produce bactericidal effects by interfering with the ability of susceptible bacteria to build their cell walls when they are dividing. These drugs prevent the bacteria from biosynthesizing the framework of the cell wall, and the bacteria with weakened cell walls swell and then burst from osmotic pressure within the cell. Because human cells do not use the biochemical process that the bacteria use to form the cell wall, this effect is a selective toxicity.
青霉素和青霉素酶耐药性抗生素干扰易感菌细胞分裂时的细胞壁构建能力，从而产生杀菌效应。这些药物阻止细菌生物合成细胞壁组织，细胞壁消弱后的细菌因细胞内渗透压而膨胀、破裂。由于人体细胞不会使用细菌用来形成细胞壁的生化过程，所以，这一效应具有选择性毒性功能。
The penicillins are indicated for the treatment of streptococcal infections, including pharyngitis, tonsillitis, scarlet fever, and endocarditis; pneumococcal infections; staphylococcal infections; fusospirochetal infections; rat-bite fever; diphtheria; anthrax; syphilis; and uncomplicated gonococcal infections. At high doses, these drugs are also used to treat meningococcal meningitis.
The major adverse effects of penicillin therapy involve the GI tract. Common adverse effects include nausea, vomiting, diarrhea, abdominal pain, glossitis, stomatitis, gastritis, sore mouth, and furry tongue. These effects are primarily related to the loss of bacteria from the normal flora and the subsequent opportunistic infections that occur. Superinfections, including yeast infections, are also very common and are again associated with the loss of bacteria from the normal flora. Pain and inflammation at the injection site can occur with injectable forms of the drugs. Hypersensitivity reactions may include rash, fever, wheezing, and, with repeated exposure, anaphylaxis that can progress to anaphylactic shock and death.
penicillin – n. 青霉素 Penicillium molds – 青霉素酶
penicillin G benzathine – n. 苄星青霉素G Bicillin – n. 比西林 Permapen – n. 苄星青霉素制剂
penicillin G potassium – n. 青霉素G钾 Pfizerpen —n. 青霉素G制剂
penicillin G procaine – n. 普鲁卡因青霉素G Crysticillin-AS – n. 普鲁卡因青霉素商标名
penicillin V – n. 青霉素V Veetids – n. 青霉素V钾
amoxicillin – n. 阿莫西林 Amoxil – n. 奥纳欣 Trimox – n. 一种青霉素制剂
ampicillin – n. 氨苄西林 Principen – n. 氨苄西林制剂
ticarcillin – n. 替卡西林 Ticar -- n. 铁卡
penicillinase – n. 青霉素酶
nafcillin – n. 萘夫西林
oxacillin – n. 恶洒西林，苯唑西林
fusospirochetal – a. 梭菌螺旋体性的
Test 1. Both IV ampicillin/sulbactam (Unasyn) and gentamicin (Garamycin) are ordered for a patient. When administering these medications, the nurse will do what?
A. Ensure that separate IV solutions are used.
B. Use two different peripheral IV sites.
C. Administer the gentamicin first.
D. There are no necessary precautions.
2. Which instructions should a nurse provide to a patient who is to start taking amoxicillin/clavulanate (Augmentin)?
A. "Take Augmentin once per day and only at bedtime."
B. "Augmentin may be taken with food or meals."
C. "Avoid taking Augmentin with grapefruit juice."
D. "Use a minimal amount of liquid to swallow the Augmentin."
本期ISPN Review答案： 1. A. Ensure that separate IV solutions are used.
When penicillins are present in high concentrations, they interact chemically with aminoglycosides, causing inactivation of the aminoglycoside. Therefore, penicillins and aminoglycosides should not be mixed in the same IV solution. Rather, these drugs should be administered separately. Two different peripheral IV sites are not necessary. Administering the gentamicin first does not ensure separation of the two medications.
2. B. "Augmentin may be taken with food or meals."
Amoxicillin/clavulanate is a broad-spectrum aminopenicillin that may be taken with meals. Most other oral penicillins must be taken with a full glass of water 1 hour before or 2 hours after meals. Taking oral penicillins only at bedtime, avoiding grapefruit juice, and taking the drug with only minimal water are not necessary.
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