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absence of such data local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy penicillin v potassium tablets usp and penicillin v potassium for oral solution usp are indicated in the treatment of mild to moderately severe infections due to penicillin g sensitive microorganisms therapy should be guided by bacteriological studies including sensitivity tests and by clinical response note severe pneumonia empyema bacteremia pericarditis meningitis and arthritis should not be treated with penicillin v during the acute stage indicated surgical procedures should be performed the following infections will usually respond to adequate dosage of penicillin v streptococcal infections without bacteremia mild to moderate infections of the upper respiratory tract scarlet fever and mild erysipelas note streptococci in groups a c g h l and m are very sensitive to penicillin other groups including group d enterococcus are resistant pneumococcal infections mild to moderately severe infections of the respiratory tract staphylococcal infections penicillin g sensitive mild infections of the skin and soft tissues note reports indicate an increasing number of strains of staphylococci resistant to penicillin g emphasizing the need for culture and sensitivity studies in treating suspected staphylococcal infections fusospirochetosis vincent s gingivitis and pharyngitis mild to moderately severe infections of the oropharynx usually respond to therapy with oral penicillin note necessary dental care should be accomplished in infections involving the gum tissue medical conditions in which oral penicillin therapy is indicated as prophylaxis for the prevention of recurrence following rheumatic fever and or chorea prophylaxis with oral penicillin on a continuing basis has proven effective in preventing recurrence of these conditions although no controlled clinical efficacy studies have been conducted penicillin v has been suggested by the american heart association and the american dental association for use as an oral regimen for prophylaxis against bacterial endocarditis in patients with congenital heart disease or rheumatic or other acquired valvular heart disease when they undergo dental procedures and surgical procedures of the upper respiratory tract 1 oral penicillin should not be used in those patients at particularly high risk for endocarditis e g those with prosthetic heart valves or surgically constructed systemic pulmonary shunts penicillin v should not be used as adjunctive prophylaxis for genitourinary instrumentation or surgery lower intestinal tract surgery sigmoidoscopy and childbirth since it may happen that alpha haemolytic streptococci relatively resistant to penicillin may be found when patients are receiving continuous oral penicillin for secondary prevention of rheumatic fever prophylactic agents other than penicillin may be chosen for these patients and prescribed in addition to their continuous rheumatic fever 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