The penicillins remain the class of antibiotics most commonly prescribed to children worldwide. In an era when the risks posed by antimicrobial resistance are growing, an understanding of antibiotic pharmacology and how to apply these principles in clinical practice is increasingly important. This paper provides an overview of the pharmacology of penicillins, focusing on those aspects of pharmacokinetics, pharmacodynamics and toxicity that are clinically relevant in paediatric prescribing. Penicillin allergy is frequently reported but a detailed history of suspected adverse reactions is essential to identify whether a clinically relevant hypersensitivity reaction is likely or not. The importance of additional factors such as antibiotic palatability, concordance and stewardship are also discussed, highlighting their relevance to optimal prescribing of the penicillins for children.
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Contributors CB, EG and MS contributed to the preparation and review of this commissioned article.
Funding CB is funded as a Clinical Research Fellow by the Global Research in Paediatrics Network of Excellence (GRiP), part of the European Union's Seventh Framework Programme for research, technological development and demonstration (FP7/2007–2013, Grant Agreement number 261060). EG is supported by an IMPACT PhD studentship from University College London (UCL), and has received funding from the neoMero study, part of the European Union Seventh Framework Programme for research, technological development and demonstration (Grant Agreement number 242146), and also from Action Medical Research (grant code SP4650, GN1834). MS chairs the UK Department of Health expert Advisory Committee on Antimicrobial Resistance and Healthcare Associated Infection, is an independent scientific advisor to the National Institute for Health and Care Excellence (NICE), and also receives institutional academic research grants from the NIHR (National Institute for Health Research) and the European Union.
Competing interests None declared.
Provenance and peer review Commissioned; internally peer reviewed.