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penicillin G benzathine

Pronunciation

Generic Name: penicillin G benzathine (PEN i SILL in G BEN za theen)
Brand Name: Bicillin L-A

What is penicillin G benzathine?

Penicillin G benzathine is a slow-onset antibiotic that fights bacteria in your body.

Penicillin G benzathine is used to treat many different types of severe infections, including strep infections, rheumatic fever, and syphilis.

Penicillin G benzathine may also be used for purposes not listed in this medication guide.

What is the most important information I should know about penicillin G benzathine?

You should not receive this medication if you are allergic to penicillin. Tell your doctor if you have ever had an allergic reaction to a cephalosporin antibiotic such as Ceftin, Cefzil, Omnicef, Keflex, and others.

Before you receive penicillin G benzathine, tell your doctor if you have asthma or a history of allergies, liver disease, kidney disease, or heart disease.

Be sure to receive all doses your doctor has prescribed. Your symptoms may get better before the infection is completely cleared.

After you have finished your treatment with penicillin G benzathine, your doctor may want to do tests to make sure your infection has completely cleared up.

What should I discuss with my healthcare provider before receiving penicillin G benzathine?

You should not receive this medication if you are allergic to penicillin. Tell your doctor if you have ever had an allergic reaction to a cephalosporin antibiotic such as cefdinir (Omnicef), cefprozil (Cefzil), cefuroxime (Ceftin), cephalexin (Keflex), and others.

To make sure penicillin G benzathine is safe for you, tell your doctor if you have:

  • asthma or a history of allergies;

  • liver disease;

  • kidney disease; or

  • heart disease.

FDA pregnancy category B. This medication is not expected to be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment.

Penicillin G benzathine can pass into breast milk and may harm a nursing baby. Tell your doctor if you are breast-feeding a baby.

How is penicillin G benzathine given?

Penicillin G benzathine is injected into a muscle. A healthcare provider will give you this injection.

Penicillin G benzathine must be injected slowly into a muscle of the buttock.

Penicillin G benzathine is sometimes given only once or only for a few days until your symptoms clear up. Be sure to receive all doses your doctor has prescribed. Your symptoms may get better before the infection is completely cleared. Skipping doses may also increase your risk of further infection that is resistant to antibiotics.

After you have finished your treatment with penicillin G benzathine, your doctor may want to do tests to make sure your infection has completely cleared up.

What happens if I miss a dose?

Call your doctor for instructions if you miss an appointment for your penicillin G benzathine injection.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

What should I avoid while receiving penicillin G benzathine?

Antibiotic medicines can cause diarrhea, which may be a sign of a new infection. If you have diarrhea that is watery or bloody, stop taking penicillin G benzathine and call your doctor. Do not use anti-diarrhea medicine unless your doctor tells you to.

Penicillin G benzathine side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

  • diarrhea that is watery or bloody;

  • fever, swollen glands, rash or itching, muscle or joint pain, night sweats, general ill feeling;

  • a feeling like you might pass out;

  • skin rash with bruising, severe tingling, numbness, pain, muscle weakness;

  • pale or yellowed skin, dark colored urine, weakness;

  • easy bruising, unusual bleeding (nose, mouth, vagina, or rectum), purple or red pinpoint spots under your skin;

  • little or no urinating;

  • fast or pounding heartbeats;

  • slow heart rate, weak pulse, fainting, slow breathing;

  • confusion, agitation, hallucinations, ringing in your ears, unusual thoughts or behavior;

  • seizure (convulsions);

  • pain, swelling, bruising, irritation, or skin changes where the injection was given; or

  • hardening of your skin in the thigh where the injection was given, trouble bending your knee.

Common side effects may include:

  • nausea, vomiting;

  • blurred vision;

  • dizziness; or

  • tired feeling.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

Penicillin G benzathine dosing information

Usual Adult Dose for Upper Respiratory Tract Infection:

Mild to moderate infections due to susceptible group A streptococci (e.g., pharyngitis): 1.2 million units IM once

Usual Adult Dose for Tonsillitis/Pharyngitis:

Streptococcal tonsillopharyngitis treatment (primary prevention of rheumatic fever): 1.2 million units IM once

Usual Adult Dose for Rheumatic Fever Prophylaxis:

Secondary prevention of rheumatic fever (prevention of recurrence):
Manufacturer recommendation: 1.2 million units IM once a month or 600,000 units IM every 2 weeks
American Heart Association (AHA) recommendation: 1.2 million units IM every 3 to 4 weeks

For high-risk patients, penicillin G benzathine given every 3 weeks may be more effective and is recommended by the AHA. Oral penicillin can be used for prevention in lower risk patients whose compliance can be ensured.

Duration: Long-term, continuous prophylaxis is recommended.

Usual Adult Dose for Syphilis -- Early:

Primary, secondary: 2.4 million units IM once

If retreatment of primary or secondary syphilis (without neurosyphilis) is necessary, 2.4 million units IM once a week for 3 consecutive weeks has been recommended.

Usual Adult Dose for Syphilis -- Latent:

Early latent: 2.4 million units IM once

Late latent or unknown duration: 2.4 million units IM once a week for 3 consecutive weeks (total dose 7.2 million units)

Usual Adult Dose for Tertiary Syphilis:

Bicillin (R) L-A: 2.4 million units IM once a week for 3 doses
Permapen (R): 3 million units IM once a week for a total of 6 to 9 million units

The Centers for Disease Control and Prevention (CDC) and other experts recommend 2.4 million units IM once a week for 3 consecutive weeks (total dose 7.2 million units).

Usual Adult Dose for Neurosyphilis:

Bicillin (R) L-A: 2.4 million units IM once a week for 3 doses
Permapen (R): 3 million units IM once a week for a total of 6 to 9 million units

The CDC states that benzathine G penicillin, 2.4 million units IM once a week for up to 3 weeks, can be considered after completion of therapy with aqueous penicillin G or the alternative regimen of procaine penicillin plus probenecid.

Usual Adult Dose for Bacterial Infection:

Yaws, bejel, pinta: 1.2 million units IM once

Usual Adult Dose for Glomerulonephritis:

Secondary prevention: 1.2 million units IM once a month or 600,000 units IM every 2 weeks

Usual Adult Dose for Skin or Soft Tissue Infection:

Prevention of recurrent erysipelas (Milroy disease): 1.2 million units IM every 4 weeks

Usual Pediatric Dose for Bacterial Infection:

Mild to moderate infections:
1 month or older, less than 27 kg: 300,000 to 600,000 units IM once
1 month or older, 27 kg or more: 900,000 to 1,200,000 units IM once

Yaws, bejel, pinta:
For children, some clinicians recommend:
Less than 10 years: 600,000 units IM once
10 years or older: 1.2 million units IM once

Usual Pediatric Dose for Upper Respiratory Tract Infection:

Mild to moderate infections due to susceptible group A streptococci (e.g., pharyngitis):
Infants and pediatric patients less than 27 kg: 300,000 to 600,000 units IM once
Older pediatric patients: 900,000 units IM once

Usual Pediatric Dose for Tonsillitis/Pharyngitis:

Streptococcal tonsillopharyngitis treatment (primary prevention of rheumatic fever):
27 kg or less: 600,000 units IM once
Greater than 27 kg: 1.2 million units IM once

Usual Pediatric Dose for Rheumatic Fever Prophylaxis:

Secondary prevention of rheumatic fever (prevention of recurrence):
Manufacturer recommendation: 1.2 million units IM once a month or 600,000 units IM every 2 weeks

AHA recommendation:
27 kg or less: 600,000 units IM every 3 to 4 weeks
Greater than 27 kg: 1.2 million units IM every 3 to 4 weeks

For high-risk patients, penicillin G benzathine given every 3 weeks may be more effective and is recommended by the AHA. Oral penicillin can be used for prevention in lower risk patients whose compliance can be ensured.

Duration: Long-term, continuous prophylaxis is recommended.

Usual Pediatric Dose for Congenital Syphilis:

Asymptomatic neonates: 50,000 units/kg IM once
Asymptomatic infants and children: 50,000 units/kg IM once a week for up to 3 weeks
Maximum dose: 2.4 million units/dose

Any child suspected of having congenital syphilis or with neurologic involvement should be treated with aqueous penicillin G. After completion of this IV therapy, a single dose of penicillin G benzathine 50,000 units/kg IM can be considered.

Usual Pediatric Dose for Syphilis -- Early:

1 month or older:
Primary, secondary: 50,000 units/kg IM once
Maximum dose: 2.4 million units/dose

Usual Pediatric Dose for Syphilis -- Latent:

1 month or older:
Early latent: 50,000 units/kg IM once
Maximum dose: 2.4 million units/dose

Late latent or unknown duration: 50,000 units/kg IM once a week for 3 consecutive weeks
Maximum dose: 2.4 million units/dose (up to a maximum total dosage of 7.2 million units)

What other drugs will affect penicillin G benzathine?

Tell your doctor about all medicines you use, and those you start or stop using during your treatment with penicillin G benzathine, especially:

  • methotrexate;

  • probenecid;

  • birth control pills;

  • a blood thinner such as warfarin (Coumadin, Jantoven); or

  • a blood thinner such as warfarin, Coumadin; or

  • a tetracycline antibiotic--doxycycline, minocycline, tetracycline.

This list is not complete. Other drugs may interact with penicillin G benzathine, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.

Where can I get more information?

  • Your doctor or pharmacist can provide more information about penicillin G benzathine.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 2.01. Revision Date: 2013-01-21, 3:56:39 PM.

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