penicillin g aqueous

penicillin G aqueous: pen-i-SILL-in gee

penicillin G benzathine: BENZ-a-theen pen-i-SILL-in gee

Therapeutic Classification: anti-infectives

Pharmacologic Classification: penicillins

REMS

Treatment of a wide variety of infections including:
- Pneumococcal pneumonia,
- Streptococcal pharyngitis,
- Syphilis,
- Gonorrhea strains.
Treatment of enterococcal infections (requires the addition of an aminoglycoside).
Prevention of rheumatic fever.

Unlabeled Use:

Lyme disease.
Prevention of recurrent
Streptococcal pneumoniae
septicemia in children with sickle-cell disease.

Bind to bacterial cell wall, resulting in cell death.

Therapeutic effects:

Bactericidal action against susceptible bacteria.

Spectrum:

Active against:
- Most gram-positive organisms, including many streptococci (Streptococcus pneumoniae, group A beta-hemolytic streptococci), staphylococci (non–penicillinase-producing strains) and Bacillus anthracis,
- Some gram-negative organisms, such as Neisseria meningitidis and N. gonorrhoeae (only penicillin susceptible strains),
- Some anaerobic bacteria and spirochetes including Borellia burgdorferi.

Absorption: Variably absorbed from the GI tract. Benzathine penicillin G: IM absorption is delayed and prolonged and results in sustained therapeutic blood levels. IV administration results in complete bioavailability.

Distribution: Widely distributed, although CNS penetration is poor in the presence of normal (non-inflamed) meninges.

Metabolism/Excretion: Minimally metabolized by the liver, excreted mainly unchanged by the kidneys.

Half-Life: 30–60 min.

(plasma concentrations)

ROUTE	ONSET	PEAK	DURATION
Penicillin G IM	rapid	0.25–0.5 hr	4–6 hr
Benzathine penicillin IM	delayed	12–24 hr	3 wk
Penicillin G IV	rapid	end of infusion	4–6 hr

Contraindicated in:

Previous hypersensitivity to penicillins (cross-sensitivity exists with cephalosporins and other beta-lactam antibiotics);
Hypersensitivity to benzathine (benzathine preparation only);
Some products may contain tartrazine and should be avoided in patients with known hypersensitivity.

Use Cautiously in:

Severe renal impairment (dosage ↓ recommended);
Lactation: Safety not established in breastfeeding;
Geri: Consider body mass, age-related in renal/hepatic/cardiac function, and concurrent diseases/drug therapy in older adults.

Drug-drug:

May ↓ the effectiveness of oral contraceptive agents.
Probenecid↓ renal excretion and ↑ levels (therapy may be combined for this purpose).
Neomycin may ↓ absorption.
May ↓ elimination and risk of toxicity of methotrexate.

Penicillin G Aqueous

IM IV (Adults ): Most infections: 1–5 million units every 4–6 hr.
IM IV (Children ): 8333–16,667 units/kg every 4 hr; 12,550–25,000 units/kg every 6 hr; up to 250,000 units/kg/day in divided doses, some infections may require up to 300,000 units/kg/day.
IV (Infants >7 days): 75,000 units/kg/day in divided doses every 8 hr; Meningitis: 200,000–300,000 units/kg/day in divided doses every 6 hr.
IV (Infants <7 days): 50,000 units/kg/day in divided doses every 12 hr; Streptococcus B, meningitis: 100,000–150,000 units/kg/day in divided doses.

Penicillin G Benzathine

IM (Adults ): Streptococcal infections/erysipeloid: 1.2 million units single dose. Primary, secondary, and early latent syphilis: 2.4 million units single dose. Tertiary and late latent syphilis (not neurosyphilis): 2.4 million units once weekly for 3 wk. Prevention of rheumatic fever: 1.2 million units every 3–4 wk.
IM (Children >27 kg): Streptococcal infections/erysipeloid: 900,000–1.2 million units (single dose). Primary, secondary, and early latent syphilis: up to 2.4 million units single dose. Late latent or latent syphilis of undetermined duration: 50,000 units/kg weekly for 3 wk. Prevention of rheumatic fever: 1.2 million units every 2–3 wk.
IM (Children <27 kg): Streptococcal infections/erysipeloid: 300,000–600,000 units single dose. Primary, secondary, and early latent syphilis: up to 2.4 million units single dose. Late latent or latent syphilis of undetermined duration: 50,000 units/kg weekly for 3 wk. Prevention of rheumatic fever: 1.2 million units every 2–3 wk.

Penicillin G Potassium Aqueous

Penicillin G Sodium Aqueous

Penicillin G Benzathine

(Generic available)

Powder for injection: 5 million units/vial; 20 million units/vial
Premixed (frozen) solution for injection: 1 million units/50 mL; 2 million units/50 mL; 3 million units/50 mL
Powder for injection: 5 million units/vial
Suspension for injection: 600,000 units/mL

Assess for infection (vital signs; appearance of wound, sputum, urine, and stool; WBC) at beginning of and during therapy.
Obtain a history to determine previous use of and reactions to penicillins, cephalosporins, or other beta-lactam antibiotics. Persons with a negative history of penicillin sensitivity may still have an allergic response.
Obtain specimens for culture and sensitivity before initiating therapy. First dose may be given before receiving results.
Observe patient for signs and symptoms of anaphylaxis (rash, pruritus, laryngeal edema, wheezing). Discontinue drug and notify physician or other health care professional immediately if these symptoms occur. Keep epinephrine, an antihistamine, and resuscitation equipment close by in case of an anaphylactic reaction.
Monitor bowel function. Diarrhea, abdominal cramping, fever, and bloody stools should be reported to health care professional promptly as a sign of CDAD. May begin up to several wk following cessation of therapy.

Lab Test Considerations:

May cause positive direct Coombs’ test results.
- Hyperkalemia may develop after large doses of penicillin G potassium.
- Monitor serum sodium concentrations in patient with hypertension or HF. Hypernatremia may develop after large doses of penicillin sodium.
- May cause ↑ AST, ALT, LDH, and serum alkaline phosphatase concentrations.
- May cause leukopenia and neutropenia, especially with prolonged therapy or hepatic impairment.

acyclovir
amiodarone
atropine
aztreonam
benztropine
bumetanide
buprenorphine
butorphanol
calcium chloride
calcium gluconate
cefazolin
cefotaxime
cefotetan
cefoxitin
ceftazidime
ceftriaxone
cefuroxime
chloramphenicol
chlorpromazine
clindamycin
cyanocobalamin
cyclophosphamide
cyclosporine
dexamethasone
digoxin
diltiazem
diphenhydramine
dopamine
enalaprilat
ephedrine
epinephrine
epoetin alfa
esmolol
famotidine
fentanyl
fluconazole
folic acid
foscarnet
furosemide
glycopyrrolate
heparin
hydrocortisone
hydromorphone
imipenem/cilastatin
indomethacin
insulin, regular
isoproterenol
ketamine
ketorolac
lidocaine
magnesium sulfate
mannitol
meperidine
meropenem/vaborbactam
methylprednisolone
metoclopramide
metoprolol
midazolam
morphine
multivitamins
nafcillin
nalbuphine
naloxone
nicardipine
nitroglycerin
nitroprusside
norepinephrine
ondansetron
oxacillin
oxytocin
phenylephrine
phytonadione
plazomicin
potassium chloride
procainamide
prochlorperazine
propranolol
pyridoxine
sodium bicarbonate
sufentanil
tacrolimus
tedizolid
theophylline
thiamine
tobramycin
vasopressin
verapamil

Y-Site Incompatibility:

Incompatible with aminoglycosides; do not admix.

ascorbic acid
atropine
aztreonam
benztropine
bumetanide
buprenorphine
butorphanol
calcium chloride
calcium gluconate
cefazolin
cefotaxime
cefotetan
cefoxitin
ceftazidime
ceftriaxone
cefuroxime
chloramphenicol
clindamycin
cyanocobalamin
cyclophosphamide
cyclosporine
dexamethasone
digoxin
dimenhydrinate
diphenhydramine
dopamine
enalaprilat
ephedrine
epinephrine
epoetin alfa
esmolol
famotidine
fentanyl
fluconazole
folic acid
furosemide
glycopyrrolate
heparin
hydrocortisone
imipenem/cilastatin
indomethacin
insulin, regular
isoproterenol
ketamine
ketorolac
LR
levofloxacin
lidocaine
magnesium sulfate
mannitol
meperidine
meropenem
methylprednisolone
metoclopramide
metoprolol
midazolam
morphine
multivitamins
nafcillin
nalbuphine
naloxone
nitroglycerin
nitroprusside
norepinephrine
ondansetron
oxacillin
oxytocin
pantoprazole
penicillin G potassium
phenylephrine
phytonadione
potassium chloride
procainamide
prochlorperazine
propranolol
pyridoxine
sodium bicarbonate
sufentanil
theophylline
thiamine
vasopressin
verapamil

Y-Site Incompatibility:

Incompatible with aminoglycosides; do not admix.

Do not confuse penicillin with penicillamine. Do not confuse penicillin G aqueous (potassium/sodium salts) with penicillin G benzathine.
IM: Reconstitution: Add 8.2 mL sterile water for injection or 0.9% NaCl for a final concentration of 500,000 units/mL; add 3.2 mL for a final concentration of 1,000,000 units/mL. Shake solution well before injection.Diluent: Dilute further, up to 100,000 units/mL, for less discomfort. Inject penicillin deep into a well-developed muscle mass at a slow, consistent rate to prevent blockage of the needle. Massage well. Accidental injury near or into a nerve can result in severe pain and dysfunction. Do not inject penicillin G benzathine in deltoid or anterolateral thigh.
- Penicillin G potassium or sodium may be diluted with lidocaine (without epinephrine) 1% or 2% to minimize pain from IM injection.
- Never give penicillin G benzathine or penicillin G procaine suspensions IV. May cause embolism or toxic reactions.

Penicillin G Potassium

Penicillin G Sodium

IV Administration:

IV: Reconstitution: Add 8.2 mL sterile water for injection or 0.9% NaCl for a final concentration of 500,000 units/mL; add 3.2 mL for a final concentration of 1,000,000 units/mL. Shake solution well before injection. Store reconstituted solutions in refrigerator for up to 3 days.
Change IV sites every 48 hr to prevent phlebitis.
- Administer slowly and observe patient closely for signs of hypersensitivity.
Intermittent Infusion: Diluent: Doses of 3 million units or less should be diluted in at least 50 mL of D5W or 0.9% NaCl; doses of more than 3 million units should be diluted with 100 mL.
Rate: Infuse over 1–2 hr in adults or 15–30 min in children.
Diluent: Doses of 10 million units or more may be diluted in 1 or 2 L.
Rate: Infuse over 24 hr.

Instruct patient to take medication around the clock and to finish drug completely as directed, even if feeling better. Advise patient that sharing this medication may be dangerous.
Advise patient to report signs of superinfection (black, furry overgrowth on tongue; vaginal itching or discharge; loose or foul-smelling stools) and allergy.
Instruct patient to notify health care professional if fever and diarrhea develop, especially if stool contains blood, pus, or mucus. Advise patient not to treat diarrhea without consulting health care professional.
Instruct patient to notify health care professional if symptoms do not improve.
Rep: Advise patient taking oral contraceptives to use an additional nonhormonal method of contraception during therapy with penicillin and until next menstrual period.
Patient with an allergy to penicillin should be instructed to always carry an identification card with this information.

Resolution of signs and symptoms of infection. Length of time for complete resolution depends on the organism and site of infection.

penicillin G aqueous: Pfizerpen,

penicillin G benzathine: Bicillin L-A

section name header

Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇

Time/Action Profile ⬆ ⬇

Contraind./Precautions ⬆ ⬇

Adv. Reactions/Side Effects ⬆ ⬇

Interactions ⬆ ⬇

Route/Dosage ⬆ ⬇

Availability ⬆ ⬇

Assessment ⬆ ⬇

Implementation ⬆ ⬇

Patient/Family Teaching ⬆ ⬇

Evaluation/Desired Outcomes ⬆ ⬇

US Brand Names ⬆