Penicillins: update for clinical practice

Abstract

Introduction: The discovery of penicillins is one of the milestones in the history of health care. These drugs are among the most prescribed antimicrobials in the world, with applicability even today in different diseases and infectious complications. Objective: To review the main pharmacological and therapeutic aspects of penicillins, with emphasis on the clinical use of these drugs. Methods: Narrative literature review directed at updating the most relevant pharmacological and therapeutic aspects of penicillins: (1) history; (2) mechanisms of action and bacterial resistance; (3) penicillins and immunomodulation; and (4) classification of antimicrobials. Results: The identification of penicillin G by Alexander Fleming in 1928 inaugurated the “Age of Antibiotics”. The drugs are beta-lactams and therefore act on penicillin-binding proteins (PBPs), preventing the proper formation of peptidoglycans, which produces osmotic lysis of bacterial cells. Immunomodulatory properties of the drugs are described, the relevance of which still remains controversial. The classification of drugs allows the following groups to be distinguished: natural penicillins, aminopeniclins, isoxazolylpenicillins, carboxypenicillins, and ureidopenicillins. Conclusion: Penicillins continue to be important drugs today. The prescriber should act in accordance with the assumptions of the rational use of antimicrobials, which contributes to reducing the risk of developing bacterial resistance, a phenomenon that has acquired, in recent decades, tragic contours in different parts of the world.

Keywords

• anti-bacterial agents
• drug resistance
• bacterial
• penicillin
• penicillin-binding protein