Phenoxymethylpenicillin (Penicillin V)

Adults (including the elderly) and children over 12 years: 250 mg to 500 mg every six hours. The dosage and frequency depend on the severity and localisation of the infection and the expected pathogens. For oral administration only; take at least 30 minutes before or 2 hours after food, as ingestion with meals slightly reduces absorption. 250 mg is approximately equivalent to 400,000 units. PROPHYLACTIC USE: prophylaxis of rheumatic fever/chorea — 250 mg twice daily on a continuing basis; prophylaxis of pneumococcal infection (e.g. in asplenia and in sickle cell disease) — adults and children over 12 years 500 mg every 12 hours, children 6-12 years 250 mg every 12 hours, children below 5 years 125 mg every 12 hours. Streptococcal infections should be treated for a minimum of 10 days, with post-therapy cultures to confirm eradication (§4.4). Elderly: dosage is as for adults. Hepatic impairment: dosage adjustment may be necessary in patients with impaired liver function when they also have renal failure, as the liver may then be a major excretion route. Oral therapy should not be relied upon in patients with severe illness, or with nausea, vomiting, gastric dilation, achalasia or intestinal hypermotility. Paediatric doses in the SPC are given by age band rather than per kg (infants up to 1 year 62.5 mg every 6 hours; 1-5 years 125 mg every 6 hours; 6-12 years 250 mg every 6 hours), so no mg/kg dose is expressed here — verify any under-18 use against a children's formulary. The source product is an oral solution (125 mg/5 ml powder for oral solution) containing sucrose — not for patients with rare hereditary fructose intolerance, glucose-galactose malabsorption or sucrase-isomaltase insufficiency.