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Overdose and Treatment: Mild to moderate toxicity: Nausea, vomiting, abdominal pain and diarrhea may develop with ingestion. Skin rashes and urticaria may develop, especially with amoxicillin and ampicillin ingestions. Hematuria, crystalluria and transient renal insufficiency have been reported after amoxicillin overdose.
Treatment is symptomatic and supportive. Treat significant vomiting and diarrhea with IV fluids; administer antiemetics, as needed. Administer antihistamines, with or without inhaled beta agonists, corticosteroids or epinephrine for hypersensitivity reaction.
Severe toxicity: Agitation, confusion, hallucinations, stupor, coma, multifocal myoclonus, seizures and encephalopathy may occur following massive doses of IV penicillins (40 to 100 million units/day). Cardiac arrest and death have been associated with inadvertent intravenous administration of penicillin G (benzathine and procaine). Hyperkalemia may also develop.
Acute anaphylaxis is more likely to occur after parenteral exposure, but may develop with all routes. Administer oxygen, aggressive airway management, antihistamines, epinephrine, corticosteroids, ECG monitoring, and IV fluids. Dysrhythmias should be treated with standard antiarrhythmic drugs, if necessary.
Seizures: Initially treat with IV benzodiazepines.
