Procaine Penicillin Dosage

Usual Adult Dose for Skin or Soft Tissue Infection

600,000 to 1,000,000 units/day IM for at least 10 days

Uses: Moderately severe to severe group A streptococcal infections (tonsillitis, erysipelas, scarlet fever, upper respiratory tract, skin and soft tissue)/moderately severe to severe infections of the upper respiratory tract, skin and soft tissue infections, scarlet fever, and erysipelas due to susceptible streptococci (group A without bacteremia)

Usual Adult Dose for Upper Respiratory Tract Infection

600,000 to 1,000,000 units/day IM for at least 10 days

Uses: Moderately severe to severe group A streptococcal infections (tonsillitis, erysipelas, scarlet fever, upper respiratory tract, skin and soft tissue)/moderately severe to severe infections of the upper respiratory tract, skin and soft tissue infections, scarlet fever, and erysipelas due to susceptible streptococci (group A without bacteremia)

Usual Adult Dose for Tonsillitis/Pharyngitis

600,000 to 1,000,000 units/day IM for at least 10 days

Uses: Moderately severe to severe group A streptococcal infections (tonsillitis, erysipelas, scarlet fever, upper respiratory tract, skin and soft tissue)/moderately severe to severe infections of the upper respiratory tract, skin and soft tissue infections, scarlet fever, and erysipelas due to susceptible streptococci (group A without bacteremia)

Usual Adult Dose for Streptococcal Infection

600,000 to 1,000,000 units/day IM for at least 10 days

Uses: Moderately severe to severe group A streptococcal infections (tonsillitis, erysipelas, scarlet fever, upper respiratory tract, skin and soft tissue)/moderately severe to severe infections of the upper respiratory tract, skin and soft tissue infections, scarlet fever, and erysipelas due to susceptible streptococci (group A without bacteremia)

Usual Adult Dose for Endocarditis

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

Uses:

• Moderately severe (uncomplicated) pneumococcal pneumonia/moderately severe infections of the respiratory tract due to susceptible pneumococci
• Moderately severe to severe staphylococcal infections/moderately severe infections of the skin and soft tissues due to susceptible staphylococci (penicillin G-susceptible)
• Subacute bacterial endocarditis (only in extremely sensitive infections) due to susceptible group A streptococci
• Cutaneous anthrax due to Bacillus anthracis
• Vincent's infection (fusospirochetosis)/moderately severe infections of the oropharynx due to susceptible fusiform bacilli and spirochetes (fusospirochetosis [Vincent's gingivitis and pharyngitis])
• Erysipeloid due to Erysipelothrix rhusiopathiae
• Rat-bite fever due to susceptible Streptobacillus moniliformis and Spirillum minus organisms

Usual Adult Dose for Fusospirochetosis

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

Uses:

• Moderately severe (uncomplicated) pneumococcal pneumonia/moderately severe infections of the respiratory tract due to susceptible pneumococci
• Moderately severe to severe staphylococcal infections/moderately severe infections of the skin and soft tissues due to susceptible staphylococci (penicillin G-susceptible)
• Subacute bacterial endocarditis (only in extremely sensitive infections) due to susceptible group A streptococci
• Cutaneous anthrax due to Bacillus anthracis
• Vincent's infection (fusospirochetosis)/moderately severe infections of the oropharynx due to susceptible fusiform bacilli and spirochetes (fusospirochetosis [Vincent's gingivitis and pharyngitis])
• Erysipeloid due to Erysipelothrix rhusiopathiae
• Rat-bite fever due to susceptible Streptobacillus moniliformis and Spirillum minus organisms

Usual Adult Dose for Pneumonia

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

Uses:

• Moderately severe (uncomplicated) pneumococcal pneumonia/moderately severe infections of the respiratory tract due to susceptible pneumococci
• Moderately severe to severe staphylococcal infections/moderately severe infections of the skin and soft tissues due to susceptible staphylococci (penicillin G-susceptible)
• Subacute bacterial endocarditis (only in extremely sensitive infections) due to susceptible group A streptococci
• Cutaneous anthrax due to Bacillus anthracis
• Vincent's infection (fusospirochetosis)/moderately severe infections of the oropharynx due to susceptible fusiform bacilli and spirochetes (fusospirochetosis [Vincent's gingivitis and pharyngitis])
• Erysipeloid due to Erysipelothrix rhusiopathiae
• Rat-bite fever due to susceptible Streptobacillus moniliformis and Spirillum minus organisms

Usual Adult Dose for Bacterial Infection

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

Uses:

• Moderately severe (uncomplicated) pneumococcal pneumonia/moderately severe infections of the respiratory tract due to susceptible pneumococci
• Moderately severe to severe staphylococcal infections/moderately severe infections of the skin and soft tissues due to susceptible staphylococci (penicillin G-susceptible)
• Subacute bacterial endocarditis (only in extremely sensitive infections) due to susceptible group A streptococci
• Cutaneous anthrax due to Bacillus anthracis
• Vincent's infection (fusospirochetosis)/moderately severe infections of the oropharynx due to susceptible fusiform bacilli and spirochetes (fusospirochetosis [Vincent's gingivitis and pharyngitis])
• Erysipeloid due to Erysipelothrix rhusiopathiae
• Rat-bite fever due to susceptible Streptobacillus moniliformis and Spirillum minus organisms

Usual Adult Dose for Cutaneous Bacillus anthracis

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

Uses:

• Moderately severe (uncomplicated) pneumococcal pneumonia/moderately severe infections of the respiratory tract due to susceptible pneumococci
• Moderately severe to severe staphylococcal infections/moderately severe infections of the skin and soft tissues due to susceptible staphylococci (penicillin G-susceptible)
• Subacute bacterial endocarditis (only in extremely sensitive infections) due to susceptible group A streptococci
• Cutaneous anthrax due to Bacillus anthracis
• Vincent's infection (fusospirochetosis)/moderately severe infections of the oropharynx due to susceptible fusiform bacilli and spirochetes (fusospirochetosis [Vincent's gingivitis and pharyngitis])
• Erysipeloid due to Erysipelothrix rhusiopathiae
• Rat-bite fever due to susceptible Streptobacillus moniliformis and Spirillum minus organisms

Usual Adult Dose for Rat-bite Fever

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

Uses:

• Moderately severe (uncomplicated) pneumococcal pneumonia/moderately severe infections of the respiratory tract due to susceptible pneumococci
• Moderately severe to severe staphylococcal infections/moderately severe infections of the skin and soft tissues due to susceptible staphylococci (penicillin G-susceptible)
• Subacute bacterial endocarditis (only in extremely sensitive infections) due to susceptible group A streptococci
• Cutaneous anthrax due to Bacillus anthracis
• Vincent's infection (fusospirochetosis)/moderately severe infections of the oropharynx due to susceptible fusiform bacilli and spirochetes (fusospirochetosis [Vincent's gingivitis and pharyngitis])
• Erysipeloid due to Erysipelothrix rhusiopathiae
• Rat-bite fever due to susceptible Streptobacillus moniliformis and Spirillum minus organisms

Usual Adult Dose for Anthrax Prophylaxis

1.2 million units IM every 12 hours
Total duration of therapy: 60 days

Comments:

• Safety of this drug at this dose has not been established for more than 2 weeks of use; the risks/benefits of continuing this drug beyond 2 weeks or switching to an effective alternate therapy should be considered.

Use: Inhalational anthrax (postexposure) to reduce incidence/progression of infection after exposure to aerosolized Bacillus anthracis

Usual Adult Dose for Neurosyphilis

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

Use: Late syphilis (tertiary, neurosyphilis) due to susceptible Treponema pallidum

US CDC and Panel on Opportunistic Infections in Adults and Adolescents with HIV Recommendations: 2.4 million units IM once a day for 10 to 14 days

Comments:

• US CDC: If compliance can be ensured, recommended with probenecid as an alternative regimen for neurosyphilis
• Panel on Opportunistic Infections in Adults and Adolescents with HIV: Recommended with probenecid as alternative therapy for neurosyphilis or otic or ocular syphilis
• Current guidelines should be consulted for additional information.

Usual Adult Dose for Tertiary Syphilis

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

Use: Late syphilis (tertiary, neurosyphilis) due to susceptible Treponema pallidum

US CDC and Panel on Opportunistic Infections in Adults and Adolescents with HIV Recommendations: 2.4 million units IM once a day for 10 to 14 days

Comments:

• US CDC: If compliance can be ensured, recommended with probenecid as an alternative regimen for neurosyphilis
• Panel on Opportunistic Infections in Adults and Adolescents with HIV: Recommended with probenecid as alternative therapy for neurosyphilis or otic or ocular syphilis
• Current guidelines should be consulted for additional information.

Usual Adult Dose for Syphilis - Latent

With a negative spinal fluid: 600,000 units/day IM for 8 days
Total dosage: 4,800,000 units

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

Use: Latent syphilis due to susceptible T pallidum

Usual Adult Dose for Syphilis - Early

600,000 units/day IM for 8 days
Total dosage: 4,800,000 units

Uses: Primary and secondary syphilis due to susceptible T pallidum

Usual Adult Dose for Bejel

The usual treatment is the same as for syphilis in the corresponding stage of disease.

Uses: Bejel, pinta, yaws due to susceptible organisms

Usual Adult Dose for Yaws

The usual treatment is the same as for syphilis in the corresponding stage of disease.

Uses: Bejel, pinta, yaws due to susceptible organisms

Usual Adult Dose for Pinta

The usual treatment is the same as for syphilis in the corresponding stage of disease.

Uses: Bejel, pinta, yaws due to susceptible organisms

Usual Adult Dose for Diphtheria

Adjunctive therapy with antitoxin: 300,000 to 600,000 units/day IM
Carrier state: 300,000 units/day IM for 10 days

Uses: Adjunct to antitoxin for prevention of carrier stage of diphtheria due to susceptible Corynebacterium diphtheriae; diphtheria carrier state

US CDC Recommendations: 600,000 units every 12 hours for 14 days

Comments:

• Antimicrobial therapy is necessary to stop toxin production, eradicate C diphtheriae organism, and prevent transmission; it is not a substitute for antitoxin.
• Patients usually are not contagious 48 hours after starting therapy.
• Eradication of the organism should be confirmed 24 hours after completion of therapy by 2 consecutive negative cultures from specimens taken 24 hours apart.
• Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Pneumonia

Less than 27 kg: 300,000 units/day IM

Uses:

• Pneumonia/moderately severe infections of the respiratory tract due to susceptible pneumococci
• Streptococcal (group A) infections/moderately severe to severe infections of the upper respiratory tract, skin and soft tissue infections, scarlet fever, and erysipelas due to susceptible streptococci (group A without bacteremia)
• Staphylococcal infections/moderately severe infections of the skin and soft tissues due to susceptible staphylococci (penicillin G-susceptible)

American Academy of Pediatrics (AAP) Recommendations:
Neonates: 50,000 units/kg IM every 24 hours
1 month or older: 50,000 units/kg/day IM divided in 1 or 2 doses

• Maximum dose: 1.2 million units/day

Comments:

• This drug is not safe for IV administration.
• Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Skin or Soft Tissue Infection

Less than 27 kg: 300,000 units/day IM

Uses:

• Pneumonia/moderately severe infections of the respiratory tract due to susceptible pneumococci
• Streptococcal (group A) infections/moderately severe to severe infections of the upper respiratory tract, skin and soft tissue infections, scarlet fever, and erysipelas due to susceptible streptococci (group A without bacteremia)
• Staphylococcal infections/moderately severe infections of the skin and soft tissues due to susceptible staphylococci (penicillin G-susceptible)

American Academy of Pediatrics (AAP) Recommendations:
Neonates: 50,000 units/kg IM every 24 hours
1 month or older: 50,000 units/kg/day IM divided in 1 or 2 doses

• Maximum dose: 1.2 million units/day

Comments:

• This drug is not safe for IV administration.
• Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Upper Respiratory Tract Infection

Less than 27 kg: 300,000 units/day IM

Uses:

• Pneumonia/moderately severe infections of the respiratory tract due to susceptible pneumococci
• Streptococcal (group A) infections/moderately severe to severe infections of the upper respiratory tract, skin and soft tissue infections, scarlet fever, and erysipelas due to susceptible streptococci (group A without bacteremia)
• Staphylococcal infections/moderately severe infections of the skin and soft tissues due to susceptible staphylococci (penicillin G-susceptible)

American Academy of Pediatrics (AAP) Recommendations:
Neonates: 50,000 units/kg IM every 24 hours
1 month or older: 50,000 units/kg/day IM divided in 1 or 2 doses

• Maximum dose: 1.2 million units/day

Comments:

• This drug is not safe for IV administration.
• Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Bacterial Infection

Less than 27 kg: 300,000 units/day IM

Uses:

• Pneumonia/moderately severe infections of the respiratory tract due to susceptible pneumococci
• Streptococcal (group A) infections/moderately severe to severe infections of the upper respiratory tract, skin and soft tissue infections, scarlet fever, and erysipelas due to susceptible streptococci (group A without bacteremia)
• Staphylococcal infections/moderately severe infections of the skin and soft tissues due to susceptible staphylococci (penicillin G-susceptible)

American Academy of Pediatrics (AAP) Recommendations:
Neonates: 50,000 units/kg IM every 24 hours
1 month or older: 50,000 units/kg/day IM divided in 1 or 2 doses

• Maximum dose: 1.2 million units/day

Comments:

• This drug is not safe for IV administration.
• Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Streptococcal Infection

Less than 27 kg: 300,000 units/day IM

Uses:

• Pneumonia/moderately severe infections of the respiratory tract due to susceptible pneumococci
• Streptococcal (group A) infections/moderately severe to severe infections of the upper respiratory tract, skin and soft tissue infections, scarlet fever, and erysipelas due to susceptible streptococci (group A without bacteremia)
• Staphylococcal infections/moderately severe infections of the skin and soft tissues due to susceptible staphylococci (penicillin G-susceptible)

American Academy of Pediatrics (AAP) Recommendations:
Neonates: 50,000 units/kg IM every 24 hours
1 month or older: 50,000 units/kg/day IM divided in 1 or 2 doses

• Maximum dose: 1.2 million units/day

Comments:

• This drug is not safe for IV administration.
• Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Anthrax Prophylaxis

Children: 25,000 units/kg IM every 12 hours

• Maximum dose: 1.2 million units/dose

Total duration of therapy: 60 days

Comments:

• Safety of this drug at this dose has not been established for more than 2 weeks of use; the risks/benefits of continuing this drug beyond 2 weeks or switching to an effective alternate therapy should be considered.

Use: Inhalational anthrax (postexposure) to reduce incidence/progression of infection after exposure to aerosolized B anthracis

Usual Pediatric Dose for Congenital Syphilis

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

US CDC and AAP Recommendations: 50,000 units/kg IM once a day for 10 days

• Maximum dose: 2.4 million units/day

Comments:

• Recommended for neonates with proven or highly probable congenital syphilis, neonates with possible congenital syphilis, and neonates with or without clinical evidence of congenital syphilis (proven/highly probable, possible, or less likely) when aqueous crystalline penicillin G is unavailable
• Recommended for infants and children with or without clinical evidence of congenital syphilis (proven/highly probable, possible, or less likely) when aqueous crystalline penicillin G is unavailable
• Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Syphilis - Early

Greater than 12 years: 600,000 units/day IM for 8 days
Total dosage: 4,800,000 units

Use: Primary, secondary, and latent with a negative spinal fluid

Usual Pediatric Dose for Syphilis - Latent

Greater than 12 years: 600,000 units/day IM for 8 days
Total dosage: 4,800,000 units

Use: Primary, secondary, and latent with a negative spinal fluid

Usual Pediatric Dose for Neurosyphilis

Panel on Opportunistic Infections in Adults and Adolescents with HIV Recommendations: 2.4 million units IM once a day for 10 to 14 days

Comments:

• Recommended with probenecid as alternative therapy for neurosyphilis or otic or ocular syphilis in adolescents
• Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Diphtheria

US CDC Recommendations:

• Up to 10 kg: 300,000 units IM every 12 hours
• Greater than 10 kg: 600,000 units IM every 12 hours

AAP Recommendations:

• Aged 1 month or older: 50,000 units/kg/day IM divided in 1 or 2 doses
• Maximum dose: 1.2 million units/day

Duration of Therapy: 14 days

Comments:

• Antimicrobial therapy is necessary to stop toxin production, eradicate C diphtheriae organism, and prevent transmission; it is not a substitute for antitoxin.
• Patients usually are not contagious 48 hours after starting therapy.
• Eradication of the organism should be confirmed 24 hours after completion of therapy by 2 consecutive negative cultures from specimens taken 24 hours apart.
• Current guidelines should be consulted for additional information.

Renal Dose Adjustments

Data not available

Comments:

• Excretion is considerably delayed in patients with impaired renal function.

Liver Dose Adjustments

Data not available

Precautions

US BOXED WARNING:

• The warnings, adverse reactions, and dosage and administration sections of the manufacturer product information should be carefully read before administering this drug.

CONTRAINDICATIONS:
Previous hypersensitivity reaction to any penicillin

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Other Comments

Administration advice:

• For IM injection only; do not inject into or near an artery or nerve; may cause permanent neurologic damage if injected into or near a nerve
• Administer by deep IM injection in the upper, outer quadrant of the buttock (dorsogluteal) or the ventrogluteal site; may prefer the midlateral aspect of the thigh in neonates, infants, and small children
• The needle may be blocked if the drug is not injected at a slow, steady rate (due to high concentration of suspended material in product).
• Rotate the injection site when doses are repeated.
• Do not use this drug for severe infections (e.g., severe pneumonia, empyema, bacteremia [including streptococcal infections with bacteremia], pericarditis, meningitis, peritonitis, pneumococcal arthritis) during the acute stage or when high, sustained serum drug levels are required; use aqueous penicillin G (IM or IV).
• Do not use this drug for prophylaxis against bacterial endocarditis; use penicillin V (or aqueous penicillin G if patient unable to take oral medications) when prophylaxis is necessary.
• Do not use this drug to treat beta-lactamase-producing organisms (including most strains of Neisseria gonorrhoeae); this drug is no longer indicated to treat gonorrhea.

Storage requirements:

• Store in refrigerator at 2C to 8C (36F to 46F); keep from freezing.

General:

• To reduce the development of drug-resistant organisms and maintain effective therapy, antibiotics should be used only to treat or prevent infections proven or strongly suspected to be caused by susceptible bacteria.
• Culture and susceptibility information should be considered when selecting/modifying antibacterial therapy or, if no data are available, local epidemiology and susceptibility patterns may be considered when selecting empiric therapy.
• This drug should only be used for indications listed in the manufacturer product information; this drug is for the treatment of moderately severe infections due to penicillin-G-sensitive microorganisms susceptible to the low and persistent serum levels typical of this formulation.
• Bacteriological studies (including susceptibility tests) and clinical response should guide therapy.
• Groups A, C, G, H, L, and M streptococci are very susceptible to penicillin G; other groups (including group D [enterococci]) are resistant; aqueous penicillin is recommended for streptococcal infections with bacteremia.
• An increasing number of strains of staphylococci are resistant to penicillin G, emphasizing the importance of culture and sensitivity studies when treating suspected staphylococcal infections; indicated surgical procedures should be performed.
• Completion of necessary dental care recommended with infections involving gum tissue.
• Excretion is considerably delayed in neonates and young infants.

Monitoring:

• General: Laboratory studies, including susceptibility tests with suspected staphylococcal infections; serological tests if concomitant syphilis suspected (monthly for at least 4 months)
• Hematologic: Hematopoietic systems (during prolonged therapy, especially with high-dose regimens)
• Renal: Renal systems (during prolonged therapy, especially with high-dose regimens); renal function in elderly patients

Patient advice:

• Avoid missing doses and complete the entire course of therapy.
• Seek immediate medical attention if the following signs/symptoms develop: pale, gray, or blue colored skin (cyanosis); headache; rapid heart rate; shortness of breath; lightheadedness; or fatigue.
• Consult physician at once if watery and bloody stools (with or without stomach cramps and fever) develop.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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