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The early origins of oral penicillin dosing for children
Optimal dosing of antibiotics maximises efficacy while minimising toxicity and the selection of resistance. Dosing regimens of older off-patent antibiotics are long established clinically but the origins of these doses are often unclear. In 2011, we noted that dosing of the penicillins in paediatrics had remained unchanged for over 50 years and was no longer optimal due to changes in children’s weights.1 The aim of this paper is to explore further the very early origins of the dosing of oral phenoxymethylpenicillin (penicillin V), as the first oral penicillin used in children.
History of oral penicillin V use in children
Being able to administer penicillin orally was always a clear goal for children where the original doses given as high-volume intramuscular injections were particularly painful. As far as we have been able to determine, the first reported use of oral penicillin in a child was from 1940 in a 6-month-old boy with a Staphylococcus aureus urinary tract infection.2 Further studies in babies and young infants of oral benzylpenicillin (penicillin G) demonstrated good oral absorption, but that children over the age of 6–12 months rapidly degraded the drug because of high gastric acidity.3 The development of penicillin V in 1948, capable of withstanding gastric acid, was a clear step forward for paediatric use. The first large series of penicillin V being administered to children, that we can identify, was from Germany in 1953 in 106 children. The dose was based on the weight of the child (<15 kg=15 mg given four hourly, 15–30 kg=30 mg four hourly, >30 kg=30 mg three hourly).4 One of the first recorded uses of oral penicillin V in children from the UK was reported …
Contributors ES, PL and MS conceived and drafted the paper with contributions from SS, JB, CB and ICKW.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Patient consent for publication Not required.