Penicillin Update
Stuart L. Goldstein MD
Sheldon L. Kaplan MD
Ralph D. Feigin MD1
1 Professor and Chair, Department of Pediatrics, Baylor College of Medicine, Houston, TX.
Penicillin was discovered serendipitously by Alexander Fleming in 1928 while he was examining Staphylococcus variants. The first trials of penicillin in humans who had serious staphylococcal infections were undertaken more than I decade later and yielded impressive therapeutic results. Despite the introduction of numerous other antimicrobial agents and the emergence of many organisms resistant to penicillin, this agent remains a powerful and essential antibiotic 50 years after its first clinical application.
Pharmacology
The basic structure of the penicillins consists of the thiazolidine ring, a beta-lactam ring, and a side chain (Figure 1). The antimicrobial activity of all penicillins is produced by the thiazolidine/beta-lactam nucleus, and the organism-specific activity of a particular penicillin is determined by the side chain derivative. There are many naturally occurring side chain derivatives, but penicillin G is the most potent of these and, therefore, the only one used clinically. Semisynthetic penicillins are constructed from the basic penicillin nucleus with a side chain added. Each side chain alters the susceptibility of a particular penicillin to inactivating enzymes.
MECHANISM OF ACTION
All pencillins work by inhibiting bacterial cell wall synthesis, thereby affecting the stability of the cell wall and subsequent bacterial development. The cell wall is made of a peptidoglycan that is synthesized in three stages.
MECHANISM OF ACTION
