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Benzyl penicillin, also known as penicillin G, is a narrow-spectrum beta-lactam antibiotic used to treat a variety of serious bacterial infections. It exerts its bactericidal effect by binding to penicillin-binding proteins (PBPs) located inside the bacterial cell wall, thereby inhibiting the final transpeptidation step of peptidoglycan synthesis and leading to cell lysis. In the 'First Line Antimicrobials in Children With Complicated Severe Acute Malnutrition' (FLACSAM) Phase 3 clinical trial led by the University of Oxford, benzyl penicillin is administered parenterally in combination with gentamicin as the WHO-recommended standard of care. The study aims to compare this traditional regimen against newer antibiotic strategies, such as ceftriaxone and metronidazole, to improve survival and recovery rates in severely malnourished children who are at high risk of mortality due to infection.
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