Procaine Penicillin Dosage

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Usual Adult Dose for Skin or Soft Tissue Infection

Moderately severe to severe infections due to susceptible group A streptococci: 600,000 to 1,000,000 units/day IM for at least 10 days

Usual Adult Dose for Upper Respiratory Tract Infection

Moderately severe to severe infections due to susceptible group A streptococci: 600,000 to 1,000,000 units/day IM for at least 10 days

Usual Adult Dose for Tonsillitis/Pharyngitis

Moderately severe to severe infections due to susceptible group A streptococci: 600,000 to 1,000,000 units/day IM for at least 10 days

Usual Adult Dose for Streptococcal Infection

Erysipelas, scarlet fever:
Moderately severe to severe infections due to susceptible group A streptococci: 600,000 to 1,000,000 units/day IM for at least 10 days

Usual Adult Dose for Pneumonia

Moderately severe (uncomplicated) infections due to susceptible pneumococci: 600,000 to 1,000,000 units/day IM

Usual Adult Dose for Bacterial Infection

Moderately severe to severe infections due to susceptible staphylococci and uncomplicated infections due to Erysipelothrix rhusiopathiae: 600,000 to 1,000,000 units/day IM

Bejel, pinta, and yaws: The usual treatment is the same as for syphilis in the corresponding stage of disease.

Usual Adult Dose for Anthrax Prophylaxis

1.2 million units IM every 12 hours

Duration: Anthrax prophylaxis should continue for 60 days. Safety of procaine penicillin has not been established for more than 2 weeks of use. Consider an alternate treatment beyond 2 weeks.

Usual Adult Dose for Cutaneous Bacillus anthracis

600,000 to 1,000,000 units/day IM

Although 5 to 10 days of treatment may be adequate for mild, uncomplicated cutaneous anthrax (naturally occurring or endemic exposures), the Centers for Disease Control and Prevention (CDC) recommend continuing therapy for 60 days if cutaneous anthrax occurs as a result of exposure to aerosolized Bacillus anthracis spores.

Usual Adult Dose for Neurosyphilis

600,000 units/day IM for 10 to 15 days
Total dose: 6 to 9 million units

If compliance can be ensured, the CDC recommends: Procaine penicillin 2.4 million units IM once a day plus probenecid 500 mg orally 4 times a day for 10 to 14 days; may follow with penicillin G benzathine 2.4 million units IM once a week for up to 3 weeks

IV penicillin G is the recommended regimen for the treatment of neurosyphilis. All patients should undergo clinical and serological testing every 6 months for 2 to 3 years.

Usual Adult Dose for Tertiary Syphilis

600,000 units/day IM for 10 to 15 days
Total dose: 6 to 9 million units

All patients should undergo clinical and serological testing every 6 months for 2 to 3 years.

Usual Adult Dose for Syphilis - Latent

Latent with a negative spinal fluid: 600,000 units/day IM for 8 days
Total dose: 4,800,000 units

Latent with positive or no spinal fluid examination: 600,000 units/day IM for 10 to 15 days
Total dose: 6 to 9 million units

The CDC recommends penicillin G benzathine as the drug of choice for the treatment of latent syphilis. All patients should undergo clinical and serological testing every 6 months for 2 to 3 years.

Usual Adult Dose for Syphilis - Early

Primary and secondary: 600,000 units/day IM for 8 days
Total dose: 4,800,000 units

The CDC recommends penicillin G benzathine as the drug of choice for the treatment of primary or secondary syphilis. All patients should undergo clinical and serological testing every 6 months for 2 to 3 years.

Usual Adult Dose for Diphtheria

Adjunctive therapy with antitoxin: 300,000 to 600,000 units/day IM for 14 days; the CDC recommends 300,000 units/day IM for patients weighing 10 kg or less and 600,000 units/day IM for patients weighing more than 10 kg

Patients usually are not contagious 48 hours after starting therapy. Two consecutive negative cultures after treatment is completed should be obtained to confirm eradication of the organism.

Carrier state: 300,000 units/day IM

Follow-up cultures at least 2 weeks after treatment is completed are recommended. If positive, erythromycin and additional follow-up cultures are recommended.

Usual Adult Dose for Fusospirochetosis

600,000 to 1,000,000 units/day IM

Usual Adult Dose for Rat-bite Fever

600,000 to 1,000,000 units/day IM

Usual Adult Dose for Endocarditis

Only in extremely sensitive infections: 600,000 to 1,000,000 units/day IM

Usual Pediatric Dose for Bacterial Infection

The American Academy of Pediatrics (AAP) recommends 50,000 units/kg IM once a day for neonates and 25,000 to 50,000 units/kg/day IM in 1 or 2 divided doses (maximum adult dose 4.8 million units/day) for children older than 1 month of age.

Moderately severe to severe infections due to susceptible staphylococci in patients weighing less than 27 kg: 300,000 units/day IM

Usual Pediatric Dose for Streptococcal Infection

Moderately severe to severe infections due to susceptible group A streptococci in patients weighing less than 27 kg: 300,000 units/day IM

Usual Pediatric Dose for Pneumonia

Moderately severe (uncomplicated) infections due to susceptible pneumococci in patients weighing less than 27 kg: 300,000 units/day IM

Usual Pediatric Dose for Anthrax Prophylaxis

25,000 units/kg IM every 12 hours

Duration: Anthrax prophylaxis should continue for 60 days. Safety of procaine penicillin has not been established for more than 2 weeks of use. Consider an alternate treatment beyond 2 weeks.

Usual Pediatric Dose for Congenital Syphilis

Less than 32 kg: 50,000 units/day IM for 10 days

The CDC and AAP recommend readministration of the entire course of therapy if more than 1 day is missed.

Usual Pediatric Dose for Neurosyphilis

Greater than 12 years: 600,000 units/day IM for 10 to 15 days
Total dose: 6 to 9 million units

If compliance can be ensured, the CDC recommends: Procaine penicillin 2.4 million units IM once a day plus probenecid 500 mg orally 4 times a day for 10 to 14 days; may follow with penicillin G benzathine 2.4 million units IM once a week for up to 3 weeks

IV penicillin G is the recommended regimen for the treatment of neurosyphilis. All patients should undergo clinical and serological testing every 6 months for 2 to 3 years.

Usual Pediatric Dose for Tertiary Syphilis

Greater than 12 years: 600,000 units/day IM for 10 to 15 days
Total dose: 6 to 9 million units

All patients should undergo clinical and serological testing every 6 months for 2 to 3 years.

Usual Pediatric Dose for Syphilis - Latent

Greater than 12 years:
Latent with a negative spinal fluid: 600,000 units/day IM for 8 days
Total dose: 4,800,000 units

Latent with positive or no spinal fluid examination: 600,000 units/day IM for 10 to 15 days
Total dose: 6 to 9 million units

The CDC recommends penicillin G benzathine as the drug of choice for the treatment of latent syphilis. All patients should undergo clinical and serological testing every 6 months for 2 to 3 years.

Usual Pediatric Dose for Syphilis - Early

Greater than 12 years:
Primary and secondary: 600,000 units/day IM for 8 days
Total dose: 4,800,000 units

The CDC recommends penicillin G benzathine as the drug of choice for the treatment of primary or secondary syphilis. All patients should undergo clinical and serological testing every 6 months for 2 to 3 years.

Usual Pediatric Dose for Diphtheria

Adjunctive therapy with antitoxin: The CDC recommends 300,000 units/day IM for patients weighing 10 kg or less and 600,000 units/day IM for patients weighing more than 10 kg. The AAP recommends 25,000 to 50,000 units/kg/day in 2 divided for 14 days with a maximum dose of 1.2 million units per day.

Patients usually are not contagious 48 hours after starting therapy. Two consecutive negative cultures after treatment is completed should be obtained to confirm eradication of the organism.

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

Data not available

Precautions

Serious and occasionally fatal hypersensitivity reactions have been reported with antibiotics. The drug should be discontinued immediately at the first appearance of a skin rash or other signs of hypersensitivity. Severe, acute hypersensitivity reactions may require treatment with adrenaline and other resuscitative measures including oxygen, intravenous fluids, antihistamines, corticosteroids, cardiovascular support and airway management as clinically indicated.

Clostridium difficile associated diarrhea (CDAD) has been reported with almost all antibiotics and may potentially be life-threatening. Therefore, it is important to consider this diagnosis in patients who present with diarrhea following penicillin therapy. Mild cases generally improve with discontinuation of the drug, while severe cases may require supportive therapy and treatment with an antimicrobial agent effective against C difficile. Hypertoxin producing strains of C difficile cause increased morbidity and mortality; these infections can be resistant to antimicrobial treatment and may necessitate colectomy.

Procaine penicillin is for deep intramuscular injection only. Injection of any penicillin into or near an artery or a nerve is contraindicated due to the risk of severe neurovascular damage (i.e., transverse myelitis with permanent paralysis, gangrene requiring amputation, and necrosis and sloughing at and around the injection site). Intravascular administration has also resulted in immediate pallor, mottling, or cyanosis of the extremity followed by bleb formation, and severe edema requiring anterior and/or exterior compartment fasciotomy in lower extremities, especially in infants and small children.

IV penicillin G is preferable to IM administration in neonates since sterile abscesses and procaine toxicity occur more frequently with this age group than older patients.

High doses of procaine penicillin may result in toxic procaine concentrations. It is not recommended for cases where high and sustained serum levels of penicillin are necessary.

Some patients may have procaine sensitivity. Procaine penicillin preparations should not be used in such patients.

Periodic monitoring of renal, hepatic, and hematologic function is recommended during high-dose or prolonged therapy because the risk of neutropenia and serum sickness-like reactions may be increased.

The risk of adverse effects may be elevated in patients with impaired renal function and elderly patients are more likely to have renal insufficiency. In general, dose selection for elderly patients should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased renal, hepatic, or cardiac function, and of concomitant disease or other drug therapy. It may be useful to monitor renal function in elderly patients.

Superinfection with nonsusceptible organisms may occur with the use of antibiotics. Constant observation of the patient is essential. If new infections due to bacteria or fungi appear during treatment, the drug should be discontinued and appropriate measures taken.

Due to low plasma levels, procaine penicillin should not be used for severe infections during the acute stage where high sustained penicillin plasma concentrations are required; intramuscular or intravenous aqueous penicillin G should be used instead.

Procaine penicillin is no longer indicated in the treatment of gonorrhea.

If procaine penicillin is used to treat gonococcal infections and syphilis is suspected, clinical and serologic testing should be performed before treatment and monthly for at least 4 months. If penicillin is used to treat syphilis, all patients should undergo clinical and serological testing every 6 months for 2 to 3 years.

In patients with streptococcal infections, clinicians should take measure to ascertain that therapy is sufficient to eradicate the organism and to prevent streptococcal sequelae.

To reduce the risk of development of drug-resistant organisms, antibiotics should only be used to treat or prevent proven or suspected infections caused by bacteria. Culture and susceptibility information should be considered when selecting treatment or, if no data are available, local epidemiology and susceptibility patterns may be considered when selecting empiric therapy.

Dialysis

Data not available

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