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Prophylactic: Recurrence of rheumatic fever. Treatment of mild to moderate infections caused by sensitive organisms: Pneumococcal infections of the middle ear; Streptococcal otitis media and sinusitis; Streptococcal pharyngitis caused by Strep pyogenes; mild to moderate pulmonary and periodontal anaerobic infections; gingivostomatitis; early Lyme disease.


Phenoxymethylpenicillin should not be given to patients known to be allergic to penicillin and should be given with care to patients with a history of allergy to cephalosporins. Cases of cross sensitivity have been reported. It should not be given to babies, in the neonatal period, born of hypersensitive mothers. It is not recommended for chronic, severe or deep-seated infections such as subacute bacterial endocarditis, meningitis or syphilis.

Adverse reactions:

Phenoxymethylpenicillin may produce diarrhoea, nausea and heartburn. Allergic reactions which may include exfoliative dermatitis, other skin rashes, interstitial nephritis and vasculitis, may occur. A generalised sensitivity reaction with urticaria, fever, joint pains and eosinophilia can develop within a few hours to several weeks after starting treatment. Superinfection by resistant species, such as Pseudomonas or Candida, which do not respond to penicillin therapy may occur. A sore mouth and a black hairy tongue have been reported. Increases in liver enzyme values have been reported. Care should be taken when high doses are given to patients with renal impairment (because of the risk of neurotoxicity) or congestive heart failure. Renal and haematological systems should be monitored during prolonged and high dose therapy. Care should be taken when treating patients with syphilis, as the Jarisch-Herxheimer reaction may occur shortly after starting treatment. This reaction, manifesting as fever, chills, headache and reactions at the site of the lesion, can be dangerous in cardiovascular syphilis or where there is a serious risk of increased local damage such as with optic atrophy. Haemolytic anaemia and leucopenia, prolongation of bleeding time and defective platelet function have been observed. Convulsions and other signs of toxicity to the CNS may occur particularly in patients with renal failure. Disturbances of blood electrolytes may follow the administrations of large doses of this medicine. High doses should be used with caution in patients receiving potassium containing medicines or potassium-sparing diuretics.


Phenoxymethylpenicillin should not be combined with bacteriostatic antibiotics. Combinations with other antibiotics should be considered if their effects can be expected to be synergistic or at least additive. The combination partners should be fully dosed. (Exception: In combination with a proven synergistic action, the dose of the more toxic combination partner may be reduced.) Competitive inhibition of drug elimination should be remembered, whenever anti-inflammatories, antirheumatics, antipyretics (particularly indomethacin, phenylbutazone, salicylates in high doses) or probenecid are used concomitantly. Ingestion of phenoxymethylpenicillin with meals reduce the absorption of the drug. Like other antibiotics, phenoxymethylpenicillin may reduce the efficacy of oral contraceptives. During treatment with phenoxymethylpenicillin non-enzymatic urinary glucose tests and uribilinogen tests may be false-positive. Urinary amino acid quantitations with ninhydrin may also be false-positive.


When this medicine is administered to a patient with penicillin sensitivity, anaphylactic shock may occur. Adrenaline, corticosteroids and antihistamines should be used to treat anaphylaxis. Use with caution in patients with known history of allergy.



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