Adult Dosing
Pneumonia (uncomplicated pneumococcal)
- 600,000-1,000,000 units/day IM
Group A streptococcal infections (moderately severe to severe URTI, tonsillitis, pharyngitis, otitis media, erysipelas, scarlet fever, skin and soft-tissue infections)
- 600,000-1,000,000 units/day IM for a minimum 10 days
Staphylococcal infections (moderately severe to severe)
- 600,000-1,000,000 units/day IM
Group A bacterial endocarditis [only in extremely sensitive infections]
- 600,000-1,000,000 units/day IM
Syphilis
Primary, secondary, and latent syphilis with a negative spinal fluid
- 600,000 units/day IM x 8 days (total 4,800,000 units)
Late syphilis (tertiary, neurosyphilis, and latent syphilis with positive spinal-fluid examination or no spinal-fluid examination)
- 600,000 units/day IM x 10-15 days (total 6-9 million units)
Neurosyphilis
- 2,400,000 units IM qd x 10-14 days; give with probenecid 500 mg PO qid
Yaws, Bejel, and Pinta
- Treatment as for syphilis in corresponding stage of disease
Adjunctive therapy with antitoxin in diphtheria
- 300,000-600,000 units/day IM x 14 days
Diphtheria carrier state
- 300,000 units IM/day x 10 days
Anthrax-cutaneous
- 600,000-1,000,000 units/day IM
Anthrax-inhalation (post-exposure)
- 1,200,000 units IM q12 hrs x 60 days
- Safety information for penicillin G procaine at the above dose would best support a duration of therapy of
2 wks - Assess risks vs benefits of continuous administration of this drug for >2 wks or switching to an effective alternative treatment
Necrotizing ulcerative gingivitis (Vincent’s infection, trench mouth, Fusobacterium gingivitis or pharyngitis)
- 600,000-1,000,000 units/day IM
Erysipeloid
- 600,000-1,000,000 units/day IM
Rat-bite fever
- 600,000-1,000,000 units/day IM
Notes:- Do not inject into or near an artery or nerve, as it may result in permanent neurological damage
- For IM use only
- Administer deep intramuscular injections into the upper, outer quadrant of the buttock at a slow, steady rate. On repeated doses, vary the injection site
Pediatric Dosing
Pneumonia (uncomplicated pneumococcal)
- Children <60 pounds: 300,000 units/day IM
- Children >60 pounds: 600,000-1,000,000 units/day IM
Group A streptococcal infections (moderately severe to severe URTI, tonsillitis, pharyngitis, otitis media, erysipelas, scarlet fever, skin and soft-tissue infections, subacute endocarditis)
Children <2 kg
Children <27 kg
- 300,000 units/day IM x10-14 days
Children >27 kg
- 600,000-1,000,000 units/day IM for a minimum 10 days
Syphilis
Primary, secondary, and latent syphilis with a negative spinal-fluid examination
- Children >12 yrs: 600,000 units/day x 8 days (Total: 4,800,000 units)
Late syphilis (tertiary and latent syphilis with positive spinal-fluid examination or no spinal-fluid examination)
- Children >12 yrs: 600,000 units/day IM x 10-15 days (total 6-9 million units)
Neurosyphilis
- Adolescents: 2,400,000 units IM qd x 10-14 days; give with probenecid 500 mg PO qid
Congenital syphilis (<70-lb body wt)
- 50,000 units/kg/day IM x 10 days
- Repeat the entire course if >1 day of therapy is missed
Adjunctive therapy with antitoxin in diphtheria
- 25,000-50,000 units/kg/day IM q12hrs x 14 days
- Max: 1,200,000 units/day
Anthrax-cutaneous
- 25,000-50,000 units/kg/day IM
Anthrax-inhalation (post-exposure)
- 25,000 units/kg IM q12 hrs x 60 days
- Max: 1,200,000 units
- Safety information for penicillin G procaine at the above dose would best support a duration of therapy of 2 wks
- Assess risks vs benefits of continuous administration of this drug for >2 wks or switching to an effective alternative treatment
Necrotizing ulcerative gingivitis (Vincent’s infection, trench mouth, Fusobacterium gingivitis or pharyngitis)
- 25,000-50,000 units/kg/day IM q12-24 hrs
Erysipeloid
- 25,000-50,000 units/kg/day IM q12-24 hrs
Rat-bite fever
- 25,000-50,000 units/kg/day IM x 7-10 days
Notes:- Do not inject into or near an artery or nerve, as it may result in permanent neurological damage
- For IM use only
- Administer deep intramuscular injection into the upper, outer quadrant of the buttock at a slow, steady rate. However, in neonates, infants and small children, the midlateral aspect of the thigh is preferred. On repeated doses, vary the injection site
[Outline]
- Administer penicillin G procaine only after carefully reading warnings, adverse reactions, and dosage and administration sections of prescribing information [US Black Box Warning]
- Prescribe penicillin G procaine only for the indications mentioned in its insert. It is no longer indicated in the treatment of gonorrhea
- Serious and occasionally fatal hypersensitivity or anaphylactic reactions have been reported in patients on penicillin therapy which is more likely to occur in individuals with an hx of penicillin hypersensitivity and/or a hx of sensitivity to multiple allergens. Cases of severe reactions have been reported in patients with a hx of penicillin hypersensitivity when treated with cephalosporins
- Carefully inquire regarding previous hypersensitivity reactions to penicillins, cephalosporins, or other allergens prior to initiating penicillin therapy. Discontinue therapy on occurrence of any allergic reactions and initiate appropriate medical therapy. Manage serious anaphylactic reactions with immediate treatment with epinephrine, oxygen, intravenous steroids, and airway management, including intubation, as indicated
- Therapy may cause pseudomembranous colitis that may range in severity from mild to life-threatening. Consider this diagnosis in patients presenting with diarrhea following administration of antibacterial agents and initiate therapeutic measures on confirmation of diagnosis. Treatment with antibacterial agents alters the normal flora of the colon and may permit overgrowth of clostridium. Discontinue therapy to manage mild cases; in moderate to severe cases, consider management of fluids and electrolytes, protein supplementation and antibacterial drug clinically effective against C. difficile colitis
- Procaine administration may result in immediate toxic reactions in certain individuals, particularly with a large single dose (4.8 million units). Such reactions may manifest as mental disturbances (including anxiety, confusion, agitation, depression, weakness, seizures, hallucinations, combativeness, and expressed fear of impending death). Reactions are transient, lasting for 15-30 minutes
- Do not inject into or near an artery or nerve as it may result in permanent neurological damage
- Inadvertent intravascular administration of penicillin G procaine, including inadvertent direct intra-arterial injection or injection immediately adjacent to arteries, may cause severe neurovascular damage (including transverse myelitis with permanent paralysis, gangrene requiring amputation, and necrosis and sloughing at and surrounding the injection site). These severe effects have been reported following injections into the buttock, thigh, and deltoid areas and occur most frequently in infants and small children
- Immediate pallor, mottling, or cyanosis of the extremity, both distal and proximal to the injection site, followed by bleb formation; severe edema requiring anterior and/or posterior compartment fasciotomy in the lower extremity have also been reported following suspected intravascular administration of the drug. Immediately consult an appropriate specialist if evidence of compromised blood supply occurs at proximal to or distal to the injection site. Repeated IM injections of penicillin preparations into anterolateral thigh may cause quadriceps femoris fibrosis and atrophy
- Antibiotic use may result in overgrowth of nonsusceptible organisms; monitor continuously. Discontinue therapy on occurrence of new infections due to bacteria or fungi and institute appropriate measures
- Withdraw penicillin on occurrence of allergic reactions unless, in the opinion of the physician, the condition being treated is life-threatening and amenable only to penicillin therapy
- Perform appropriate laboratory examination (including susceptibility tests) in suspected staphylococcal infections
- Evaluate renal and hematopoietic systems periodically in case of prolonged therapy with penicillin and particularly with high-dose regimen. Use of penicillin for >2 weeks, in such situations, may be associated with an increased risk of neutropenia and an increased incidence of serum sickness-like reactions
- Conduct proper diagnostic procedures such as dark-field examinations when treating gonococcal infections suspecting primary or secondary syphilis
- Perform monthly serological tests (for at least 4 months) in all cases in which concomitant syphilis is suspected
Cautions: Use cautiously in
- Renal impairment
- Hypersensitivity to multiple allergens
- Elderly patients
- Non-anaphylactic reactions to beta-lactams
- Asthma
- Seizure disorder
Pregnancy Category:B
Breastfeeding: Use of penicillin G procaine is acceptable during lactation. Amounts of drug ingested by the infant are small and are expected to cause no adverse effects. Disruption of the infant's gastrointestinal flora, leading to diarrhea or thrush, has been reported occasionally with penicillins; however, these effects are inadequately evaluated. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 14 September 2011). Penicillins are excreted in breast milk. Manufacturer advises caution.
US Trade Name(s)
US Availability
penicillin G procaine (generic)
- INJ SUSP: 1 mL (600,000 U/syringe)
- INJ SUSP: 2 mL (1,200,000 U/syringe)
Canadian Trade Name(s)
Canadian Availability
UK Trade Name(s)
UK Availability
Australian Trade Name(s)
Australian Availability
[Outline]