Adult Dosing
Tonsillitis or Group A Beta Hemolytic Streptococcal Pharyngitis
Syphilis
- Primary, secondary, and latent: 2,400,000 units IM x 1
- Late (tertiary and neurosyphilis): 2,400,000 units IM at 7-day intervals for three doses
Yaws, Bejel, and Pinta
Prophylaxis for rheumatic fever and glomerulonephritis
- 1,200,000 units IM qmonth; alt: 600,000 units IM q2wks
Pediatric Dosing
Tonsillitis or Group A Beta Hemolytic Streptococcal Pharyngitis
- 900,000 units IM x 1
- <60 lbs: 300,000-600,000 units IM x 1
Syphilis
- 2-12 yrs: adjust dosage based on adult dosage regimen
- Congenital: <2yrs 50,000 units/kg/body weight
Yaws, Bejel, and Pinta
- <10 yrs: 600,000 units IM x 1
- >10 yrs: 1,200,000 units IM x 1
Prophylaxis for rheumatic fever and glomerulonephritis
- 1,200,000 units IM qmonth; alt: 600,000 units IM q2wks
Pharyngitis (Acute) [Non-FDA Approved]
- >27 kgs: 1,200,000 units IM x 1
- <27 kgs: 600,000 units IM x 1
[Outline]
- Serious and occasionally fatal anaphylactic reactions have been reported with penicillin therapy, more likely to occur in patients with previous history of penicillin hypersensitivity and/or history of hypersensitivity to multiple allergens. Patient with history of penicillin hypersensitivity have experienced severe reaction with cephalosporins
- Take a careful history of previous hypersensitivity reaction to penicillin, cephalosporins or multiple allergens, before initiating penicillin therapy. If anaphylactic reactions occurs, discontinue the drug immediately and provide emergency treatment with epinephrine, oxygen, intravenous steroids and airway management including intubation
- Do not inject into or near an artery or nerve, as injection into or near a nerve may cause permanent neurological damage and intra-arterial injection or injection near arteries can cause gangrene requiring amputation of digits and necrosis and sloughing at and surrounding the injection site
- Inadvertent intravenous administration of penicillin G benzathine can cause cardiorespiratory arrest and death. Do not administer intravenously or admix with other intravenous solutions [US Black Box Warning]
- Repeated intramuscular injections of penicillin preparations into the anterolateral thigh may cause quadriceps femoris fibrosis and atrophy
- Prescribing antibiotics in the absence of proven or strongly suspected bacterial infection increases the risk of development of drug-resistant bacteria
- Superinfections due to bacteria or fungi can occur during the therapy. Discontinue therapy and/or institute appropriate therapy if such infections occurs
- Nearly all antibacterial agents (including penicillin G) have been reported with pseudomembranous colitis ranging from mild to life-threatening. Consider pseudomembranous colitis in patients presenting with diarrhea following administration of antibacterial agents and on confirmation of diagnosis initiate therapeutic measures. Discontinue therapy to manage mild cases while in moderate to severe cases, consider fluids and electrolyte management, protein supplementation and antibacterial drug clinically effective against C. difficile colitis
Cautions: Use cautiously in
- Renal impairment
- Hepatic impairment
- Histories of significant allergies and/or asthma
Pregnancy Category:B
Breastfeeding: Use of penicillin g is acceptable during breastfeeding. Single maternal doses of 2.4 million units intramuscularly produce low levels in milk that are not expected to cause adverse effects in breastfed infants. Disruption of the infant's gastrointestinal flora, resulting in diarrhea or thrush, has been reported occasionally but has not been adequately evaluated. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 20 June 2011). Manufacturer advises caution.
