Clin Microbiol Infect

Is penicillin V a viable first-line option for pneumonia?

September 3, 2025

Study details: This retrospective registry-based study analyzed 34,306 cases of community-acquired pneumonia treated in Swedish primary care between February 2018 and December 2021. The analysis included children over 5 years and adults. The study compared treatment failure rates between penicillin V (PcV) and amoxicillin using adjusted odds ratios (aORs) and propensity score matching. Primary outcomes were hospitalization for lower respiratory tract infection or all-cause mortality; secondary outcome was antibiotic switch.

Results: PcV was prescribed in 19,761 cases and amoxicillin in 2,363. Hospitalization or death occurred in 3.8% of PcV cases vs. 4.9% with amoxicillin (aOR, 1.07; 95% confidence interval [CI], 0.87–1.32). Antibiotic switch was more frequent with PcV than amoxicillin (aOR, 0.58; 95% CI, 0.50–0.67). Propensity score analysis confirmed similar hospitalization/mortality risk and higher switch rates with PcV.

Clinical impact: PcV demonstrated comparable effectiveness to amoxicillin for pneumonia in primary care. In settings with low resistance (similar to those in Scandinavian countries), it may be a viable first-line option, supporting antimicrobial stewardship by favoring narrow-spectrum agents. However, clinicians should remain vigilant for local resistance trends and consider broader-spectrum agents in patients with risk factors for non-pneumococcal or resistant infections.

Source:

Cronberg O, et al. (2025, August 23). Clin Microbiol Infect. Penicillin V as first-line treatment of pneumonia in primary care: a registry-based study. https://pubmed.ncbi.nlm.nih.gov/40854461/