Adult Dosing

Serious infections due to susceptible strains of streptococci (septicemia, empyema, pneumonia, pericarditis, endocarditis and meningitis)

• 12-24 million units/day IV in divided doses q4-6 hrs, depending on the severity of infection

Serious infections due to susceptible strains of staphylococci (septicemia, empyema, pneumonia, pericarditis, endocarditis and meningitis)

• 5-24 million units/day IV in divided doses q4-6 hrs, depending on the severity of infection

Anthrax

• 8 million units/day IV in divided doses q6 hrs, may give higher dose if required

Actinomycosis

Cervicofacial disease

• 1-6 million units/day IV in divided doses q4-6 hrs

Thoracic and abdominal disease

• 10-20 million units/day IV in divided doses q4-6 hrs

Clostridial infections

• Botulism: 20 million units/day IV in divided doses q4-6 hrs, as adjunctive therapy to antitoxin
• Gas gangrene: 20 million units/day IV in divided doses q4-6 hrs, adjuvant to debridement and/or surgery as indicated
• Tetanus: 20 million units/day IV in divided doses q4-6 hrs, as adjunctive therapy to human tetanus immune globulin

Diphtheria

• 2-3 million units/day IV in divided doses q4-6 hrs x 10-12 days, as adjunctive therapy to antitoxin

Erysipelothrix endocarditis

• 12-20 million units/day IV in divided doses q4-6 hrs x 4-6 wks

Fusospirochetosis

• 5-10 million units/day IV in divided doses q4-6 hrs

Listeria infections

Meningitis

• 15-20 million units/day IV in divided doses q4-6 hrs x 2 wks

Endocarditis

• 15-20 million units/day IV in divided doses q4-6 hrs x 4 wks

Pasteurella infections including bacteremia and meningitis

• 4-6 million units/day IV in divided doses q4-6 hrs x 2 wks

Haverhill fever, Rat-bite fever

• 12-20 million units/day IV in divided doses q4-6 hrs x 3-4 wks

Disseminated gonococcal infections

• 10 million units/day IV in divided doses q4-6 hrs

Syphilis (neurosyphilis)

• 12-24 million units/day IV, as 2-4 MU IV q4 hrs x 10-14 days
• May give additional therapy with Benzathine Penicillin G 2.4 MU/wk IM x 3 dose after completion of IV therapy

Meningococcal meningitis and/or septicemia

• 24 million units/day, as 2 million units IV every 2 hrs

Pfizerpen

Severe infections due to Susceptible Strains of Streptococci, Pneumococci, and Staphylococci

• Min: 5 units/day IM/IV

Gonorrheal endocarditis

• Min 5 million units/day IM/IV

Actinomycosis

• 1-6 million units/day IM/IV

Meningococcic meningitis

• 1-2 million units IM q2 hrs
• Alt: 20-30 million units/day as continuous IV drip

Clostridial infections

• 20 million units/day IM/IV, as adjunctive therapy to antitoxin

Fusospirochetal infections–

• 5–10 million units/day IM/IV

Rat-bite fever

• 12–15 million units/day IM/IV x 3–4 wks

Listeria infections

• Meningitis: 15–20 million units/day IM/IV x 2 wks
• Endocarditis: 15–20 million units/day IM/IV x 4 wks

Pasteurella infections (Bacteremia and meningitis)

• 4–6 million units/day IM/IV x 2 weeks

Erysipeloid (Endocarditis)

• 2–20 million units/day IM/IV x 4–6 wks

Gram-negative bacillary infections (Bacteremia)

• 20–80 million units/day IM/IV

Diphtheria

• 300,000–400,000 units/day IM/IV in divided doses x 10–12 days

Anthrax

• Min: 5 million units/day IM/IV in divided doses until cure is effected

Prophylaxis against bacterial endocarditis in patients w/ congenital heart disease or rheumatic or other acquired valvular heart disease undergoing dental procedures or surgical procedures of the upper respiratory tract

• 1 million units IM mixed with 600,000 units procaine penicillin G given 1/2-1 hr before procedure

• Buffered Penicillin G Potassium for Injection may be given intramuscularly or by continuous intravenous drip. Solutions containing up to 100,000 or greater units of penicillin per mL of diluent can be used as IM injection, However when large dose is required, administer by continuous intravenous drip
• For intrapleural or other local infusion, give 1/4 or 1/2 the amount of fluid aspirated or prepare as intramuscular injection
• The intrathecal use of penicillin in meningitis must be highly individualized and should be employed only with full consideration of the possible irritating effects, preferred route is intravenous, supplemented by intramuscular injection

Pediatric Dosing

Serious infections

• 150,000-300,000 units/kg/day IV in divided doses q4-6 hrs, depending on the severity of infection

Meningitis caused by susceptible strains of pneumococcus and meningococcus

• 250,000 units/kg/day IV in divided doses q4 hrs x 7-14 days depending on the severity of infection
• Max: 12-20 million units/day

Disseminated Gonococcal Infections

Arthritis

• <45 kg: 100,000 units/kg/day IV in divided doses q6 hrs x 7-10 days
• >45 kg: 10 million units/day IV in divided doses q6 hrs, depending on the type of infection

Meningitis

• <45 kg: 250,000 units/kg/day IV in divided doses q6 hrs, x 10-14 days
• >45 kg: 10 million units/day IV in divided doses q6 hrs, depending on the type of infection

Endocarditis

• <45 kg: 250,000 units/kg/day IV in divided doses q6 hrs, x 4 wks
• >45 kg: 10 million units/day IV in divided doses q6 hrs, depending on the type of infection

Syphilis (congenital and neurosyphilis)

• 200,000-300,00 units/kg/day IV , as 50, 000 units/kg q4-6 hrs x 10-14 days

Diphtheria

• 150,000-250,000 units/kg/day IV in divided doses q6 hrs x 7-10 days

Rat-bite fever; Haverhill fever

• 150,000-250,000 units/kg/day IV in divided doses q6 hrs x 4 wks

Prophylaxis against bacterial endocarditis1 in patients w/ congenital heart disease or rheumatic or other acquired valvular heart disease undergoing dental procedures or surgical procedures of the upper respiratory tract [Pfizerpen]

• 30,000 units/kg IM mixed with 600,000 units procaine penicillin G given 1/2-1 hr before procedure

• Buffered Penicillin G Potassium for Injection may be given intramuscularly or by continuous intravenous drip. Solutions containing up to 100,000 or greater units of penicillin per mL of diluent can be used as IM injection, However when large dose is required, administer by continuous intravenous drip
• For intrapleural or other local infusion, give 1/4 or 1/2 the amount of fluid aspirated or prepare as intramuscular injection
• The intrathecal use of penicillin in meningitis must be highly individualized and should be employed only with full consideration of the possible irritating effects, preferred route is intravenous, supplemented by intramuscular injection

Botulism [Non-FDA Approved]

• 12,500 units/kg IV every q6 hrs x 7 days

[Outline]

• Adult Dosing
• Pediatric Dosing

• Septicemia
• Empyema
• Pneumonia
• Pericarditis
• Endocarditis
• Meningitis
• Anthrax
• Actinomycosis
• Botulism
• Gas gangrene
• Tetanus
• Diphtheria
• Erysipelothrix endocarditis
• Fusospirochetosis
• Listeria infections including meningitis and endocarditis
• Pasteurella infections including bacteremia and meningitis
• Haverhill fever
• Rat bite fever
• Disseminated gonococcal infections
• Syphilis
• Meningococcal meningitis and/or septicemia
• Gram-negative bacillary infections

• Hypersensitivity to any of the ingredients of the product

• N/A

Renal Dose Adjustment (Based on CrCl)

• <10 mL/min/1.73m²: Full loading dose; followed by 50% of the dose q8-10 hrs
• >10 mL/min/1.73m²: Full loading dose; followed by 50% of the dose q4-5 hrs

Hepatic Dose Adjustment

• Hepatic impairment: Dose adjustments not defined; use with caution

• 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
• Clostridium difficile associated diarrhea (CDAD) ranging from mild diarrhea to fatal colitis may occur with penicillin therapy as antibacterial agents alter the normal flora of the colon leading to overgrowth of C. difficile
• C. difficile produces toxins A and B which contribute to CDAD. Hypertoxin-producing strains cause increased morbidity and mortality since these infections can be refractory to antibiotic therapy and may require colectomy. Careful medical examination is necessary since CDAD may occur >2 months after administration of drug
• If CDAD is suspected or confirmed, discontinue the treatment; provide fluid and electrolyte management, protein supplementation along with antibiotics for C. difficile, and consider surgical evaluation as clinically needed
• High dose of penicillin g potassium should be administered slowly by intravenous route, as it may lead to electrolyte imbalance from the potassium content of the penicillin
• Superinfections due to bacteria or fungi can occur during the therapy. Indwelling intravenous catheters encourage superinfection. Discontinue therapy and/or institute appropriate therapy if such infections occurs
• Prescribing antibiotics in the absence of proven or strongly suspected bacterial infection increases the risk of development of drug-resistant bacteria
• Do not inject into or near an artery or major peripheral nerves or blood vessels, as injection into or near a nerve or vessel may cause neurovascular damage. IV injection should be given cautiously due to possibility of thrombophlebitis
• Evaluate hepatic, renal and hematopoietic systems and also cardiac and vascular status periodically if prolonged therapy with penicillin, and particularly with high-dosage of intravenous penicillin G, If any impairment of function exist or suspected, consider dose reduction

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 6 Sept 2011). Manufacturer advises caution.

• CNS: Neurotoxic react (hyperreflexia, myoclonic twitches, seizures and coma)
• GI: Pseudomembranous colitis, nausea, vomiting, stomatitis, black or hairy tongue, gastrointestinal irritation, clostridium difficile associated diarrhea
• HEMA: Neutropenia, Coombs-positive hemolytic anemia, bleeding diathesis
• METABOLIC: electrolyte disturbances, hyperkalemia
• HYPERSENSITIVITY: Allergic reactions, urticaria, pruritus, angioneurotic edema, laryngospasm, bronchospasm, hypotension, vascular collapse, death, serum sickness (fever, malaise, urticaria, myalgia, arthralgia, abdominal pain and various skin rashes, ranging from maculopapular eruptions to exfoliative dermatitis)
• GU: Renal tubular damage, interstitial nephritis, proteinuria, eosinophiluria, hematuria, rise in serum urea nitrogen
• LOCAL: Phlebitis, thrombophlebitis
• MISC: Jarisch-Herxheimer reaction (fever, chills, myalgias, headache, exacerbation of cutaneous lesions, tachycardia, hyperventilation, vasodilation with flushing and mild hypotension), superinfection

• Anti bacterial agent; inhibits the third and last stage of bacterial cell wall synthesis by binding to specific penicillin-binding proteins (PBPs) located inside the bacterial cell wall
• Metabolized by liver
• Renally excreted 58-85%
• Half-life: 42 minutes (31-50 minutes)

US Trade Name(s)

• Pfizerpen

US Availability

penicillin g potassium (generic)

• PWDR for INJ: 1,000,000 units/vial
• PWDR for INJ: 5,000,000 units/vial
• PWDR for INJ: 20,000,000 units/vial
• PWDR for INJ: 20,000 units/mL (50 mL container)
• PWDR for INJ: 40,000 units/mL (50 mL container)
• PWDR for INJ: 60,000 units/mL (50 mL container)

Pfizerpen

• PWDR for INJ: 5,000,000 units/vial
• PWDR for INJ: 20,000,000 units/vial

Canadian Trade Name(s)

• N/A

Canadian Availability

• N/A

UK Trade Name(s)

• N/A

UK Availability

• N/A

Australian Trade Name(s)

• N/A

Australian Availability

• N/A

[Outline]

Antimicrobials

Penicillins/Other Combinations

Infectious Disease

Penicillins/Other Combinations