Gastric acid partially destroys benzylpenicillin (penicillin G) and only a small and inconsistent fraction of an oral dose is absorbed. To be certain of its effect the drug must be injected. A number of acid-stable penicillins with the antibacterial range of benzylpenicillin but quite well absorbed from the gut are now available, phenoxymethylpenicillin (penicillin V) for example. In vitro phenoxymethylpenicillin is a little less effective than benzylpenicillin against streptococci1 and considerably less effective against H. influenzae and gonococci. In addition, a higher proportion of phenoxymethylpenicillin than of benzylpenicillin is bound to plasma protein.2 Though controlled trials show that oral benzylpenicillin is as effective as oral phenoxymethylpencillin for most patients with susceptible infections treated outside hospital,3–6 our consultants prefer phenoxymethylpenicillin because absorption is less variable.
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