Adult Dosing
Streptococcal Infections Group A (upper-respiratory tract infection, skin and soft-tissue infections, scarlet fever, and erysipelas)
Notes- Administer the recommended dose at a single session using multiple IM sites or use an alternate schedule, giving one-half the total dose on day 1 and one-half on day 3
- Administer by deep IM injection at a slow, steady rate in the upper, outer quadrant of the buttock; use different injection sites when doses are repeated
Pneumococcal Infections (except pneumococcal meningitis)
- 1,200,000 units IM q2-3 days until the temperature is normal for 48 hrs
Notes- Administer by deep IM injection at a slow, steady rate in the upper, outer quadrant of the buttock; use different injection sites when doses are repeated
Pediatric Dosing
Streptococcal Infections Group A (upper-respiratory tract infection, skin and soft-tissue infections, scarlet fever, and erysipelas)
- Children <30 lbs. in weight: 600,000 units IM
- Children 30-60 lbs.: 900,000-1,200,000 units IM
- Children >60 lbs.: 2,400,000 units IM
Notes- Administer the recommended dose at a single session using multiple IM sites or use an alternate schedule, giving one-half the total dose on day 1 and one-half on day 3
- Administer by deep IM injection at a slow, steady rate in the upper, outer quadrant of the buttock; however, the midlateral aspect of the thigh may be preferable in neonates, infants and small children
- Use different injection sites when doses are repeated
Pneumococcal Infections (except pneumococcal meningitis)
- 600,000 units IM q2-3 days until the temperature is normal for 48 hrs
Notes- Administer by deep IM injection at a slow, steady rate in the upper, outer quadrant of the buttock; however, the midlateral aspect of the thigh may be preferable in neonates, infants and small children
- Use different injection sites when doses are repeated
- Serious and occasionally fatal anaphylactic reactions have been reported with penicillin therapy, which are more likely to occur in individuals with a previous history of penicillin hypersensitivity and/or a history of sensitivity to multiple allergens. Such patients have experienced severe reactions with cephalosporins
- Undertake a careful history of previous hypersensitivity reactions to penicillins, cephalosporins or other multiple allergens, before initiating penicillin G therapy. If anaphylactic reactions occur, discontinue the drug immediately and provide appropriate 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 G 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 history should be undertaken since CDAD may occur >2 months after the administration of antibacterial drugs
- If CDAD is suspected or confirmed, discontinue penicillin G therapy; provide fluid and electrolyte management, protein supplementation along with antibiotics for C. difficile; also, consider surgical evaluation as clinically indicated
- Do not inject into or near an artery or nerve, as injection into or near a nerve may cause permanent neurological damage. Inadvertent intra-arterial injection or injection in close proximity to arteries can cause severe neurovascular damage, including transverse myelitis with permanent paralysis, gangrene requiring amputation of digits and more proximal portions of extremities, and necrosis and sloughing at and surrounding the injection site. Such severe reactions have been reported following injections into the buttock, thigh, and deltoid areas
- Inadvertent intravenous administration of penicillin G benzathine may cause cardiorespiratory arrest and death. Do not administer intravenously or admix with other intravenous solutions [US Black Box Warning]
- Repeated IM injections of penicillin preparations into the anterolateral thigh may cause quadriceps femoris fibrosis and atrophy
- Give a test dose of 0.1 mL of a 1-2% procaine solution intradermally before administering therapy. Development of an erythema, wheal, flare, or eruption indicates procaine sensitivity; do not use procaine penicillin preparations in such cases. Antihistaminics appear beneficial in treatment of procaine reactions
- Prescribing therapy in the absence of proven or strongly suspected bacterial infection may increase the risk of development of drug-resistant bacteria
- Prolonged use of antibiotics may result in bacterial or fungal overgrowth of nonsusceptible microorganisms; discontinue therapy and institute appropriate measures if such infections occur
- Evaluate renal and hematopoietic systems periodically if prolonged therapy with penicillin, particularly with high-dosage, is scheduled
Cautions: Use cautiously in
- Renal impairment
- Hepatic impairment
- History of significant allergies and/or asthma
- Elderly patients
Pregnancy Category:B
Breastfeeding: Use of penicillin G (benzathine/procaine) is acceptable during breastfeeding. Single maternal doses of benzathine penicillin G of 2.4 million units intramuscularly produce low levels in milk that are not expected to cause any adverse effects in breastfed infants. Disruption of the infant's gastrointestinal flora, resulting in diarrhea or thrush, has been reported occasionally with penicillins, 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 16 June 2011). Manufacturer advises caution.
